1962567990 NPI number — MADISON COUNTY MEMORIAL HOSPITAL

Table of content: DR. DURRELL PADGITT SMITH D.D.S. (NPI 1467671065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962567990 NPI number — MADISON COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADISON 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:
HEALTH TRUST PHYSICIANS CLINIC
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:
1962567990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W HUTCHINGS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTERSET
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50273-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-462-2373
Provider Business Mailing Address Fax Number:
515-462-5213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W HUTCHINGS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTERSET
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50273-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-462-2950
Provider Business Practice Location Address Fax Number:
515-462-5213
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRICKS
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
515-462-2373

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0634105 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63410 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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