1386679793 NPI number — GUTTENBERG MUNICIPAL HOSPITAL

Table of content: KATHLEEN VIRGINIA MACKERROW MS, RN, CNS, GCNS-BC (NPI 1033921200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386679793 NPI number — GUTTENBERG MUNICIPAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUTTENBERG MUNICIPAL 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:
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:
1386679793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUTTENBERG
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52052-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-252-1121
Provider Business Mailing Address Fax Number:
563-252-3120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUTTENBERG
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-252-1121
Provider Business Practice Location Address Fax Number:
563-252-3120
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STAGMAN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
563-252-1121

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5000126 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DH0857 . This is a "MEDICARE RR-PALMETTO GBA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0474429 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21169 . This is a "WELLMARK-CRNA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 07244 . This is a "WELLMARK-GSP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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