NPIMap

Organization Active NPI

Montgomery County Memorial Hospital

Doing business as Villisca Medical Clinic

  • Family Nurse Practitioner
  • Villisca, IA
National Provider Identifier
1790758092
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
690075H Issued in IA
Legal business name
MONTGOMERY COUNTY MEMORIAL HOSPITAL
Doing business as
Villisca Medical Clinic
Practice address
301 E 4TH St
Villisca, IA 50864-1146
Phone
(712) 826-4422
Fax
(712) 826-2052
NPI assigned
Feb 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ronnel K Badertscher
Title
Business Office Manager
Phone
(712) 623-7156

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 690075H IA Primary

Addresses

Primary practice location

301 E 4TH St
Villisca, IA 50864-1146

Mailing address

301 E 4TH St
Villisca, IA 50864-1146
Phone (712) 826-4422

Other names 1

  • Villisca Medical Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Montogomery Co Mem Hosp11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790758092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 E 4TH ST",
            "city": "VILLISCA",
            "state": "IA",
            "postal_code": "508641146",
            "telephone_number": "712-826-4422",
            "fax_number": "712-826-2052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E 4TH ST",
            "city": "VILLISCA",
            "state": "IA",
            "postal_code": "508641146",
            "telephone_number": "712-826-4422",
            "fax_number": "712-826-2052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BADERTSCHER",
        "authorized_official_first_name": "RONNEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "712-623-7156"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "690075H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Villisca Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Villisca, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.