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NPI Code Detail

MEDICARE: DELAWARE COUNTY MEMORIAL HOSPITAL

MEDICARE: DELAWARE COUNTY 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
109971OTHERIABCIA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982667929
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELAWARE COUNTY MEMORIAL HOSPITAL
Provider Business Mailing Address
First Line : 709 W MAIN ST
Second Line :
City : MANCHESTER
State : IA
Zip : 52057-1526
Country : US
Telephone Number : 563-927-7330
Fax Number : 563-927-7409
Provider Business Practice Location Address
First Line : 709 W MAIN ST
Second Line :
City : MANCHESTER
State : IA
Zip : 52057-1526
Country : US
Telephone Number : 563-927-7330
Fax Number : 563-927-7409
Authorized Official
Title or Position : CEO
Name : MR. LON BUTIKOFER
Credential : RN, PHD
Telephone Number : 563-927-3232
Provider Enumeration Date : 04/10/2006
Last Update Date : 01/29/2008

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1750354676 — DELAWARE COUNTY MEMORIAL HOSPITAL
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1982679429 — VICTOR SALAS M.D.
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Practice Fax: 639-277-4865

Directions to “DELAWARE COUNTY MEMORIAL HOSPITAL ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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