Basic Information
| Provider Information | |||||||||
| NPI: | 1225186638 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WINNESHIEK MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WINNESHIEK MEDICAL CENTER HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 MONTGOMERY ST | ||||||||
| Address2: | |||||||||
| City: | DECORAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 521012325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633822911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 MONTGOMERY ST | ||||||||
| Address2: | |||||||||
| City: | DECORAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 521012325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633822911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | HABERICHTER | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HOME HEALTH & HOSPICE | ||||||||
| AuthorizedOfficialTelephone: | 5633873019 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 960127H | IA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 0615534 | 05 | IA | MEDICAID |