Healthcare Provider Details

I. General information

NPI: 1235214420
Provider Name (Legal Business Name): HUMBOLDT COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 15TH ST N
HUMBOLDT IA
50548-1008
US

IV. Provider business mailing address

1000 15TH ST N
HUMBOLDT IA
50548-1008
US

V. Phone/Fax

Practice location:
  • Phone: 515-332-4200
  • Fax: 515-332-4820
Mailing address:
  • Phone: 515-332-4200
  • Fax: 515-332-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number460155H
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number460155H
License Number StateIA

VIII. Authorized Official

Name: MS. MICHELLE SLEITER
Title or Position: CEO
Credential:
Phone: 515-332-4200