Healthcare Provider Details

I. General information

NPI: 1831162023
Provider Name (Legal Business Name): MONTGOMERY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 EASTERN AVE
RED OAK IA
51566-1305
US

IV. Provider business mailing address

PO BOX 498
RED OAK IA
51566-0498
US

V. Phone/Fax

Practice location:
  • Phone: 712-623-7000
  • Fax: 712-623-7224
Mailing address:
  • Phone: 712-623-7000
  • Fax: 712-623-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number690075H
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number690075H
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number690075H
License Number StateIA

VIII. Authorized Official

Name: MR. RONALD G KLOEWER
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 712-623-7000