Provider Demographics
NPI:1053394494
Name:KEOKUK AREA HOSPITAL
Entity type:Organization
Organization Name:KEOKUK AREA HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-524-7150
Mailing Address - Street 1:1600 MORGAN ST
Mailing Address - Street 2:1ST FL CLINICAL STE.
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-3456
Mailing Address - Country:US
Mailing Address - Phone:319-524-7150
Mailing Address - Fax:319-526-8817
Practice Address - Street 1:1600 MORGAN ST
Practice Address - Street 2:1ST FL CLINICAL STE
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3456
Practice Address - Country:US
Practice Address - Phone:319-524-7150
Practice Address - Fax:319-526-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
IL1003649251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670208Medicaid
IA67020OtherBLUE CROSS BLUE SHIELD
IAF245616OtherMIDLANDS CHOICE
IA0670208Medicaid
IAF245616OtherMIDLANDS CHOICE