Healthcare Provider Details

I. General information

NPI: 1073549853
Provider Name (Legal Business Name): STEWART MEMORIAL COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 3RD ST
LAKE VIEW IA
51450-7612
US

IV. Provider business mailing address

1301 W MAIN ST
LAKE CITY IA
51449-1585
US

V. Phone/Fax

Practice location:
  • Phone: 712-665-8555
  • Fax: 712-665-2002
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 State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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