NPIMap

Organization Active NPI

Pella Regional Health Center

Doing business as Pharmacy

  • Pharmacy
  • Pella, IA
National Provider Identifier
1902829146
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
268 Issued in IA
Legal business name
PELLA REGIONAL HEALTH CENTER
Doing business as
Pharmacy
Practice address
404 Jefferson St
Pella, IA 50219-1257
Phone
(641) 628-3150
Fax
(641) 628-8901
NPI assigned
Jul 26, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PELLA REGIONAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Robert D Kroese
Title
Ceo
Phone
(641) 628-6604

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 268 IA Primary

Addresses

Primary practice location

404 Jefferson St
Pella, IA 50219-1257

Mailing address

404 Jefferson St
Pella, IA 50219-1257
Phone (641) 628-3150

Other identifiers 3

IdentifierTypeStateIssuer
268OtherIALICENSE #
1620550OtherIANCPDP #
0213298MedicaidIA

Other names 1

  • Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pella Regional HLTH Ctr13 organizations share this tax ID, including this one
Part of
Pella Regional HLTH Ctr

Other organizations with this tax ID 12

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1902829146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 JEFFERSON ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191257",
            "telephone_number": "641-628-3150",
            "fax_number": "641-628-8901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 JEFFERSON ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191257",
            "telephone_number": "641-628-3150",
            "fax_number": "641-628-8901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PELLA REGIONAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PELLA REGIONAL HEALTH CENTER",
        "enumeration_date": "2006-07-26",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "KROESE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "641-628-6604"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IA",
            "license": "268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "268",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "1620550",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0213298",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pella, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.