MEDICARE: MARENGO MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1922670751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARENGO MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	300 W MAY ST
Second Line	:
City	:	MARENGO
State	:	IA
Zip	:	52301
Country	:	US
Telephone Number	:	319-642-8068
Fax Number	:	319-642-8069

Provider Business Practice Location Address
First Line	:	402 S WALNUT ST
Second Line	:
City	:	NORTH ENGLISH
State	:	IA
Zip	:	52316-9559
Country	:	US
Telephone Number	:	319-642-8049
Fax Number	:	319-642-8077

Authorized Official
Title or Position	:	DIRECTOR OF ADMINISTRATIVE SERVICES
Name	:	MARY K WARWICK
Credential	:
Telephone Number	:	319-642-8068

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	11/02/2021

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