Healthcare Provider Details

I. General information

NPI: 1922670751
Provider Name (Legal Business Name): MARENGO MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S WALNUT ST
NORTH ENGLISH IA
52316-9559
US

IV. Provider business mailing address

300 W MAY ST
MARENGO IA
52301
US

V. Phone/Fax

Practice location:
  • Phone: 319-642-8049
  • Fax: 319-642-8077
Mailing address:
  • Phone: 319-642-8068
  • Fax: 319-642-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARY K WARWICK
Title or Position: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 319-642-8068