NPIMap

Organization Active NPI

Southwest Iowa Families Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Clarinda, IA
National Provider Identifier
1689762882
Registry record updated Dec 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SOUTHWEST IOWA FAMILIES INC
Practice address
215 E Washington St
Clarinda, IA 51632-1625
Phone
(712) 542-3501
Fax
(712) 542-4725
NPI assigned
Oct 11, 2006
Last updated
Dec 18, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Berneeta L Wagoner, LISWNPI 1699863894
Title
Agency Director
Phone
(712) 542-3501

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

215 E Washington St
Clarinda, IA 51632-1625

Mailing address

215 E Washington St
Clarinda, IA 51632-1625
Phone (712) 542-3501

Other identifiers 1

IdentifierTypeStateIssuer
10025357200OtherNENE MEDICAID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000167 IA Part B Supplier - Clinic/Group Practice 7315840428 Receives reassigned benefits from 8 practitioners
Practice locations: Clarinda, IA; Villisca, IA

National Provider Directory

National Provider Directory

Locations

215 E Washington St
Clarinda, IA 51632
Phone (712) 524-3501

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197936000000",
    "number": "1689762882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E WASHINGTON ST",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516321625",
            "telephone_number": "712-542-3501",
            "fax_number": "712-542-4725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E WASHINGTON ST",
            "city": "CLARINDA",
            "state": "IA",
            "postal_code": "516321625",
            "telephone_number": "712-542-3501",
            "fax_number": "712-542-4725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST IOWA FAMILIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2007-12-18",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "BERNEETA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "AGENCY DIRECTOR",
        "authorized_official_telephone_number": "712-542-3501",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NE MEDICAID",
            "identifier": "10025357200",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarinda, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.