1871662163 NPI number — DELAWARE COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1871662163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871662163 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:
1871662163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
709 W MAIN ST
Provider Second Line Business Mailing Address:
PO BOX 359
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52057-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 W UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52042-8187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-928-7191
Provider Business Practice Location Address Fax Number:
563-928-7090
Provider Enumeration Date:
11/08/2006

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: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0689380 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com