1710926506 NPI number — ADAIR COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1710926506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710926506 NPI number — ADAIR COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAIR 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:
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:
1710926506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 SE KENT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50849-9494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-743-2123
Provider Business Mailing Address Fax Number:
641-743-7292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FONTANELLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50846-8308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-745-4300
Provider Business Practice Location Address Fax Number:
641-743-4034
Provider Enumeration Date:
06/06/2006

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:
641-743-7234

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: 33844 . This is a "BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0685016 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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