Organization
STORY COUNTY HOSPITAL
Active
Other names
Nevada Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KEMBERLEE S PACKER (CREDENTIALING SPECIALIST)
(515) 382-7101
Entity
Organization
Contact information
Practice address
640 S 19TH ST, NEVADA, IA 50201-2902
(515) 382-5413
(515) 382-7107
Mailing address
640 S 19TH ST, NEVADA, IA 50201-2902
(515) 382-5413
(515) 382-7107
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0251553
—
IA
01
—
48680
WELLMARK BCBS
IA
Enumeration date
02/07/2006
Last updated
02/10/2017
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