1760436257 NPI number — ADAIR COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1760436257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760436257 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:
1760436257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2013
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:
50849-9454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-743-2123
Provider Business Mailing Address Fax Number:
641-743-7294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 SE 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50250-1040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-523-2950
Provider Business Practice Location Address Fax Number:
515-523-2955
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEINZEROTH
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
641-743-2123

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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: 0635052 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33845 . This is a "BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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