Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 341600000X | Ambulance | | | | No |
| 2 | 282NC0060X | General Acute Care Hospital | Critical Access | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 12895 | OTHER | IOWA | BLUE CROSS IA PRIME CARE |
| 2 | 0816 | OTHER | ILLINOIS | BLUE CROSS OF IL |
| 3 | 0600627 | MEDICAID | IOWA | |
| 4 | CD1561 | MEDICARE PIN | IOWA | |
| 5 | 60062 | OTHER | IOWA | BLUE CROSS OF IA ED |
| 6 | 0600221 | MEDICAID | IOWA | |
| 7 | A5274204 | OTHER | IOWA | JOHN DEERE HC |
| 8 | 0044289 | MEDICAID | IOWA | |
| 9 | A52742X1 | OTHER | IOWA | JOHN DEERE HC |
| 10 | 035487 | OTHER | IOWA | HEALTH ALLIANCE |
| 11 | 31122 | MEDICARE PIN | | |
| 12 | 12895 | MEDICARE PIN | IOWA | |
| 13 | IA10X3 | OTHER | IOWA | JOHN DEERE HC PROFEES |
| 14 | IA10X2 | OTHER | IOWA | JOHN DEERE HC ED |
| 15 | =========402 | MEDICAID | ILLINOIS | |
| 16 | 41054 | MEDICAID | IOWA | |
| 17 | IA10X7 | OTHER | IOWA | JOHN DEERE HC PRIME CARE |
| 18 | H72 | OTHER | IOWA | MIDLANDS |
| 19 | 13928820 | OTHER | IOWA | ACS DEPT OF LABOR |
| 20 | 161313 | MEDICARE OSCAR/CERTIFICATION | IOWA | |
| 21 | 0071084 | MEDICAID | IOWA | |
| 22 | IB1109 | MEDICARE PIN | IOWA | |
