1467434225 NPI number — BOONE COUNTY HOSPITAL

Table of content: (NPI 1467434225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467434225 NPI number — BOONE COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOONE COUNTY 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:
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:
1467434225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 UNION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOONE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50036-4821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-432-3140
Provider Business Mailing Address Fax Number:
515-433-8905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOONE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50036-4821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-433-8470
Provider Business Practice Location Address Fax Number:
515-433-8905
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KIENITZ
Authorized Official First Name:
MIKAELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
515-432-3140

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  161372 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 080125H , 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: 60026 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0600262 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0655712 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200659 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0043182 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0096636 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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