Organization
PELLA REGIONAL HEALTH CENTER
Active
Other names
Pella Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT D KROESE (CEO)
(641) 628-6604
Entity
Organization
Contact information
Practice address
405 MONROE ST, PELLA, IA 50219-1189
(641) 628-3832
(641) 628-8894
Mailing address
405 MONROE ST, PELLA, IA 50219-1189
(641) 628-3832
(641) 628-8894
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
630165H
IA
207R00000X
Internal Medicine Physician
630165H
IA
261QM1300X
Multi-Specialty Clinic/Center
Primary
630165H
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0147223
—
IA
01
—
16D0383077
CLIA NUMBER
IA
01
—
CC5750
RAILROAD MEDICARE
IA
Enumeration date
05/05/2006
Last updated
10/20/2014
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