Healthcare Provider Details

I. General information

NPI: 1578108478
Provider Name (Legal Business Name): SPENCER MUNICIPAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST AVE E STE C
SPENCER IA
51301-4342
US

IV. Provider business mailing address

1200 1ST AVE E STE C
SPENCER IA
51301-4342
US

V. Phone/Fax

Practice location:
  • Phone: 712-262-7511
  • Fax: 712-262-3658
Mailing address:
  • Phone: 712-262-7511
  • Fax: 712-262-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: BRENDA TIEFENTHALER
Title or Position: CEO
Credential:
Phone: 712-264-6111