Healthcare Provider Details

I. General information

NPI: 1558548420
Provider Name (Legal Business Name): SPENCER MUNICIPAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 OKOBOJI AVE
MILFORD IA
51351-1271
US

IV. Provider business mailing address

1200 1ST AVE E
SPENCER IA
51301-4330
US

V. Phone/Fax

Practice location:
  • Phone: 712-338-2461
  • Fax: 712-262-2310
Mailing address:
  • Phone: 712-264-6111
  • Fax: 712-264-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number210037H
License Number StateIA

VIII. Authorized Official

Name: BRENDA TIEFENTHALER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 712-264-6111