Healthcare Provider Details

I. General information

NPI: 1386679793
Provider Name (Legal Business Name): GUTTENBERG MUNICIPAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAIN ST
GUTTENBERG IA
52052
US

IV. Provider business mailing address

PO BOX 550
GUTTENBERG IA
52052-0550
US

V. Phone/Fax

Practice location:
  • Phone: 563-252-1121
  • Fax: 563-252-3120
Mailing address:
  • Phone: 563-252-1121
  • Fax: 563-252-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN STAGMAN
Title or Position: CREDENTIALING SPECIALIST
Credential: RHIT
Phone: 563-252-1121