PELLA REGIONAL HEALTH CENTER (NPI# 1104860808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104860808 |
| Entity Type | Organization |
| Organization Name | PELLA REGIONAL HEALTH CENTER |
| Other Organization Name | SULLY FAMILY HEALTH CENTER |
| Practice Address |
704 3rd St Sully IA 50251-1016 |
| Mailing Address |
P.o. Box 327 704 3rd Street Sully IA 50251 |
| Practice Telephone | 6415943150 |
| Practice Fax Number | 6415943795 |
| Mailing Telephone | 6415943150 |
| Mailing Fax Number | 6415943795 |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2014-10-20 |
| Authorized Official Name | ROBERT D KROESE (CEO) |
| Authorized Official Telephone | 6416286604 |
| Is Organization Subpart | Y |
| Parent Organization Name | PELLA REGIONAL HEALTH CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
630165H | IA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0634550 | 05 |
| Other Name | Type Code |
|---|---|
| Sully Family Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053924449 | Pella Regional Health Center | Clinic/Center | 404 S Commerce, Prairie City, IA 50228-8560 | 2020-08-26 |
| 1952773921 | Pella Regional Health Center | Clinic/Center | 611 N Hancock St, Ottumwa, IA 52501-4233 | 2015-10-29 |
| 1619030988 | Pella Regional Health Center | Residential Treatment Facility, Physical Disabilities | 408 Jefferson St, Pella, IA 50219-1257 | 2006-12-18 |
| 1447294608 | Pella Regional Health Center | Clinic/Center | 100 East Sherman Street, Monroe, IA 50170 | 2006-06-16 |
| 1245712942 | Pella Regional Health Center | Family Medicine | 100 E Jefferson St, Prairie City, IA 50228-7709 | 2018-08-30 |
| 1154709327 | Pella Regional Health Center | Clinical Medical Laboratory | 404 Jefferson St, Pella, IA 50219-1257 | 2015-05-08 |
| 1932599404 | Pella Regional Health Center | Pharmacy | 802 Washington St, Pella, IA 50219-1525 | 2015-02-04 |
| 1851722128 | Pella Regional Health Center | Family Medicine | 1210 E Vermeer Rd, Pella, IA 50219-7660 | 2013-12-11 |
| 1508101221 | Pella Regional Health Center | Clinic/Center | 920 N Quincy Ave, Ottumwa, IA 52501-3866 | 2012-12-06 |
| 1386794634 | Pella Regional Health Center | Non-Pharmacy Dispensing Site | 404 Jefferson St, Pella, IA 50219-1257 | 2007-01-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PELLA REGIONAL HEALTH CENTER | 404 Jefferson St, Pella, IA 50219-1257 |
| Street Address |
704 3RD ST |
| City | SULLY |
| State | IA |
| Zip Code | 50251-1016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912311085 | Jennifer Marie Long | Nurse Practitioner | 704 3rd St, Sully, IA 50251-1016 | 2014-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851448294 | Lynnville-sully C.s.d. | Local Education Agency (LEA) | 12476 Hwy F-62 East, Sully, IA 50251 | 2007-01-05 |
| 1750374583 | Loren J. Vos Treas | Ambulance | 601 5th St, Sully, IA 50251-0256 | 2005-08-26 |
| 1518043553 | Chad Fikse | Chiropractor | 612 4th St, Sully, IA 50251-0301 | 2006-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851448294 | Lynnville-sully C.s.d. | Local Education Agency (LEA) | 12476 Hwy F-62 East, Sully, IA 50251 | 2007-01-05 |
| 1518043553 | Chad Fikse | Chiropractor | 612 4th St, Sully, IA 50251-0301 | 2006-10-31 |
| 1750374583 | Loren J. Vos Treas | Ambulance | 601 5th St, Sully, IA 50251-0256 | 2005-08-26 |
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.