Healthcare Provider Details

I. General information

NPI: 1124112677
Provider Name (Legal Business Name): COMMUNITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 US HIGHWAY 275
HAMBURG IA
51640-5052
US

IV. Provider business mailing address

2959 US HIGHWAY 275
HAMBURG IA
51640-5052
US

V. Phone/Fax

Practice location:
  • Phone: 712-382-1515
  • Fax: 712-382-2023
Mailing address:
  • Phone: 712-382-1515
  • Fax: 712-382-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: CRISTIN A HENDRICKSON
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 712-382-1515