Provider Demographics
NPI:1124307129
Name:ACKLEY MEDICAL CENTER
Entity type:Organization
Organization Name:ACKLEY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NEDERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-847-2625
Mailing Address - Street 1:1000 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:ACKLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50601-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:
Practice Address - City:ACKLEY
Practice Address - State:IA
Practice Address - Zip Code:50601-1701
Practice Address - Country:US
Practice Address - Phone:641-847-2625
Practice Address - Fax:641-847-2509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLSWORTH MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-08
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA118827OtherLICENSE NUMBER