Provider Demographics
NPI:1427654219
Name:NORTHWEST IOWA HOSPITAL CORPORATION
Entity type:Organization
Organization Name:NORTHWEST IOWA HOSPITAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-1839
Mailing Address - Street 1:2720 STONE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3734
Mailing Address - Country:US
Mailing Address - Phone:712-279-3500
Mailing Address - Fax:309-636-4184
Practice Address - Street 1:2720 STONE PARK BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3734
Practice Address - Country:US
Practice Address - Phone:712-279-3500
Practice Address - Fax:309-636-4184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST IOWA HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory