1255657466 NPI number — ALLEN MEMORIAL HOSPITAL CORPORATION

Table of content: (NPI 1255657466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255657466 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:
Provider Other Organization Name Type Code:
6
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:
1255657466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1825 LOGAN AVE
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:
50703-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-235-5285
Provider Business Mailing Address Fax Number:
319-235-3503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 W RIDGEWAY AVE
Provider Second Line Business Practice Location Address:
SUITE 50A
Provider Business Practice Location Address City Name:
WATERLOO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50701-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-833-6050
Provider Business Practice Location Address Fax Number:
319-833-6051
Provider Enumeration Date:
04/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KNOX
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
319-235-3987

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1871678318 . This is a "ALLEN MEDICAL EQUIPMENT PARENT SITE NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0128058 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com