Provider Demographics
NPI:1609930460
Name:ELLSWORTH MUNICIPAL HOSPITAL
Entity type:Organization
Organization Name:ELLSWORTH MUNICIPAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VON MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-648-7010
Mailing Address - Street 1:920 SOUTH OAK ST.
Mailing Address - Street 2:
Mailing Address - City:IOWA FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50126-9506
Mailing Address - Country:US
Mailing Address - Phone:641-648-4631
Mailing Address - Fax:
Practice Address - Street 1:920 SOUTH OAK ST.
Practice Address - Street 2:
Practice Address - City:IOWA FALLS
Practice Address - State:IA
Practice Address - Zip Code:50126-9506
Practice Address - Country:US
Practice Address - Phone:641-648-4631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLSWORTH MUNICPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA420156H275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA66034OtherBC SWING BED PROVIDER
IA0655878Medicaid
IA0655878Medicaid