Healthcare Provider Details

I. General information

NPI: 1336356906
Provider Name (Legal Business Name): DECATUR COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 NW CHURCH ST
LEON IA
50144-1205
US

IV. Provider business mailing address

1405 NW CHURCH ST
LEON IA
50144-1266
US

V. Phone/Fax

Practice location:
  • Phone: 641-446-4871
  • Fax:
Mailing address:
  • Phone: 641-446-4871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number270089H
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number270089H
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number270089H
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number270089H
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number270089H
License Number StateIA
# 6
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier51884
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBC GROUP#
# 2
Identifier6169912
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MICHAEL JOHNSTON
Title or Position: CEO
Credential:
Phone: 641-446-4871