Healthcare Provider Details

I. General information

NPI: 1780671578
Provider Name (Legal Business Name): SPENCER MUNICIPAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/27/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 10TH ST
SPENCER IA
51301-4307
US

IV. Provider business mailing address

1200 1ST AVE E
SPENCER IA
51301-4330
US

V. Phone/Fax

Practice location:
  • Phone: 712-264-6380
  • Fax: 712-264-6470
Mailing address:
  • Phone: 712-264-6380
  • Fax: 712-264-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number37H
License Number StateIA

VIII. Authorized Official

Name: BRENDA TIEFENTHALER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 712-264-6111