Basic Information
| Provider Information | |||||||||
| NPI: | 1649471699 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CASS COUNTY MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ANITA MEDICAL CENTER RURAL HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | ANITA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500200276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127624462 | ||||||||
| FaxNumber: | 7122437423 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | ATLANTIC | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500221936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122432850 | ||||||||
| FaxNumber: | 7122437423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | STANGL | ||||||||
| AuthorizedOfficialFirstName: | ABBEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7122437804 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 1649471699 | 05 | IA | MEDICAID |