Healthcare Provider Details

I. General information

NPI: 1831230747
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: 11/01/2021
Certification Date: 11/01/2021
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 Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateIA

VIII. Authorized Official

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