Healthcare Provider Details

I. General information

NPI: 1518931286
Provider Name (Legal Business Name): AUDUBON COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 PACIFIC AVE
AUDUBON IA
50025-1052
US

IV. Provider business mailing address

515 PACIFIC AVE
AUDUBON IA
50025-1052
US

V. Phone/Fax

Practice location:
  • Phone: 712-563-2611
  • Fax: 712-563-3078
Mailing address:
  • Phone: 712-563-2611
  • Fax: 712-563-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number050107H
License Number StateIA

VIII. Authorized Official

Name: MELINDA M ALT
Title or Position: CFO
Credential:
Phone: 712-563-5305