1336231091 NPI number — ALLEN MEMORIAL HOSPITAL CORPORATION

Table of content: (NPI 1336231091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336231091 NPI number — ALLEN MEMORIAL HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEN MEMORIAL HOSPITAL CORPORATION
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:
ALLEN HOSPITAL
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:
1336231091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1825 LOGAN AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERLOO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-235-3941
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1825 LOGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50703-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-235-3941
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DELAGARDELLE
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
319-235-3987

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  070034H , 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: 010930303 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5531310 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5600108 . This is a "PHARMACY" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0601104 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60110 . This is a "BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 402069826500 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80489300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0131310 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: A5070336 . This is a "JOHN DEERE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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