Healthcare Provider Details

I. General information

NPI: 1053368191
Provider Name (Legal Business Name): MARENGO MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAY ST
MARENGO IA
52301-1261
US

IV. Provider business mailing address

300 W MAY ST
MARENGO IA
52301-1261
US

V. Phone/Fax

Practice location:
  • Phone: 319-642-5543
  • Fax: 319-642-8007
Mailing address:
  • Phone: 319-642-5543
  • Fax: 319-642-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. BARRY G GOETTSCH
Title or Position: CEO
Credential:
Phone: 319-642-5543