Healthcare Provider Details

I. General information

NPI: 1013058924
Provider Name (Legal Business Name): STEWART MEMORIAL COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W MAIN ST
LAKE CITY IA
51449-1585
US

IV. Provider business mailing address

1301 W MAIN ST
LAKE CITY IA
51449-1585
US

V. Phone/Fax

Practice location:
  • Phone: 712-464-3171
  • Fax: 712-464-3269
Mailing address:
  • Phone: 712-464-3171
  • Fax: 712-464-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIA

VIII. Authorized Official

Name: JAMES L HENKENIUS
Title or Position: CFO
Credential:
Phone: 712-464-4200