1306902051 NPI number — MITCHELL COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1306902051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306902051 NPI number — MITCHELL COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MITCHELL COUNTY MEMORIAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MITCHELL COUNTY REGIONAL HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306902051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
616 N 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSAGE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50461-1456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-732-6000
Provider Business Mailing Address Fax Number:
641-732-6025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 N 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50461-1456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-732-6000
Provider Business Practice Location Address Fax Number:
641-732-6025
Provider Enumeration Date:
12/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
641-732-6003

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0655910 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 66108 . This is a "BCBS SWING BED" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".