Provider Demographics
NPI:1992708531
Name:PALO ALTO COUNTY HOSPITAL
Entity type:Organization
Organization Name:PALO ALTO COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-852-5401
Mailing Address - Street 1:3201 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EMMETSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50536-2516
Mailing Address - Country:US
Mailing Address - Phone:712-852-5500
Mailing Address - Fax:712-852-5477
Practice Address - Street 1:3201 1ST ST
Practice Address - Street 2:
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536-2516
Practice Address - Country:US
Practice Address - Phone:712-852-5419
Practice Address - Fax:712-852-5513
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALO ALTO COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-27
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA167049251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA67049OtherBC COMMUNITY HLTH PROV #
IA0671222Medicaid
IA167049Medicare ID - Type UnspecifiedCOMMUNITY HEALTH PROV. #