Healthcare Provider Details

I. General information

NPI: 1730503319
Provider Name (Legal Business Name): BOONE COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W WALNUT ST
OGDEN IA
50212-0820
US

IV. Provider business mailing address

1015 UNION ST
BOONE IA
50036-4821
US

V. Phone/Fax

Practice location:
  • Phone: 515-275-2417
  • Fax:
Mailing address:
  • Phone: 515-432-3140
  • Fax: 515-433-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIA

VIII. Authorized Official

Name: MIKAELA KIENITZ
Title or Position: CEO
Credential:
Phone: 515-432-3140