Healthcare Provider Details

I. General information

NPI: 1255328621
Provider Name (Legal Business Name): SPENCER MUNICIPAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST AVE E
SPENCER IA
51301-4330
US

IV. Provider business mailing address

1200 1ST AVE E
SPENCER IA
51301-4330
US

V. Phone/Fax

Practice location:
  • Phone: 712-264-6111
  • Fax: 712-264-6404
Mailing address:
  • Phone: 712-264-6111
  • Fax: 712-264-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number37H
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2210100
License Number StateIA

VIII. Authorized Official

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