Healthcare Provider Details

I. General information

NPI: 1578924320
Provider Name (Legal Business Name): BOONE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 UNION ST
BOONE IA
50036-4821
US

IV. Provider business mailing address

1015 UNION ST
BOONE IA
50036-4821
US

V. Phone/Fax

Practice location:
  • Phone: 515-432-3140
  • Fax:
Mailing address:
  • Phone: 515-432-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIKAELA KIENITZ
Title or Position: CEO
Credential:
Phone: 515-432-3140