Healthcare Provider Details

I. General information

NPI: 1003479312
Provider Name (Legal Business Name): HENRY COUNTY SOLDIERS' AND SAILORS' MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W WASHINGTON ST
NEW LONDON IA
52645-1329
US

IV. Provider business mailing address

407 S WHITE ST
MOUNT PLEASANT IA
52641-2263
US

V. Phone/Fax

Practice location:
  • Phone: 319-367-2241
  • Fax:
Mailing address:
  • Phone: 319-385-3141
  • Fax: 319-385-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBB M GARDNER
Title or Position: CEO
Credential:
Phone: 319-385-6560