Provider Demographics
NPI:1053881102
Name:POTTAWATTAMIE COUNTY
Entity type:Organization
Organization Name:POTTAWATTAMIE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-242-1155
Mailing Address - Street 1:227 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-4269
Mailing Address - Country:US
Mailing Address - Phone:712-328-5792
Mailing Address - Fax:712-328-4731
Practice Address - Street 1:515 5TH AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0903
Practice Address - Country:US
Practice Address - Phone:712-242-1131
Practice Address - Fax:712-242-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0082503Medicaid