Healthcare Provider Details

I. General information

NPI: 1750354676
Provider Name (Legal Business Name): DELAWARE COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W MAIN ST
MANCHESTER IA
52057-1526
US

IV. Provider business mailing address

709 W MAIN ST PO BOX 359
MANCHESTER IA
52057-1526
US

V. Phone/Fax

Practice location:
  • Phone: 563-927-3232
  • Fax:
Mailing address:
  • Phone: 563-927-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number280123H
License Number StateIA

VIII. Authorized Official

Name: MR. LON BUTIKOFER
Title or Position: CEO
Credential: RN, PHD
Phone: 563-927-3232