1811039886 NPI number — DELAWARE COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1811039886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811039886 NPI number — DELAWARE COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELAWARE 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:
1811039886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 359
Provider Second Line Business Mailing Address:
709 W MAIN ST
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52057-0359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-927-7777
Provider Business Mailing Address Fax Number:
563-927-7518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E MISSION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRAWBERRY POINT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-933-7720
Provider Business Practice Location Address Fax Number:
563-933-6277
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUTIKOFER
Authorized Official First Name:
LON
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
563-927-7308

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 421158372 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52076B001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52057A001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0056986 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0166546 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2166546 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52076A001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421158372 . This is a "MIDLAND CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27553 . This is a "BLUE SHIELD STRAWBERRY PT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0638627 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52057B001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55409 . This is a "BLUE SHIELD MANCHESTER" identifier . This identifiers is of the category "OTHER".




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