Healthcare Provider Details

I. General information

NPI: 1871662163
Provider Name (Legal Business Name): DELAWARE COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W UNION ST
EDGEWOOD IA
52042-8187
US

IV. Provider business mailing address

709 W MAIN ST PO BOX 359
MANCHESTER IA
52057-1526
US

V. Phone/Fax

Practice location:
  • Phone: 563-928-7191
  • Fax: 563-928-7090
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LON BUTIKOFER
Title or Position: CEO
Credential:
Phone: 563-927-7308