1922670751 NPI number — MARENGO MEMORIAL HOSPITAL

Table of content: (NPI 1922670751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922670751 NPI number — MARENGO MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARENGO 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:
CMH PHARMACY - NORTH ENGLISH
Provider Other Organization Name Type Code:
5
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:
1922670751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W MAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARENGO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-642-8068
Provider Business Mailing Address Fax Number:
319-642-8069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 S WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ENGLISH
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52316-9559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-642-8049
Provider Business Practice Location Address Fax Number:
319-642-8077
Provider Enumeration Date:
07/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
WARWICK
Authorized Official First Name:
MARY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official Telephone Number:
319-642-8068

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com