Healthcare Provider Details

I. General information

NPI: 1982113163
Provider Name (Legal Business Name): SPENCER MUNICIPAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
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
51301-4342
US

IV. Provider business mailing address

6501 CITY WEST PKWY
EDEN PRAIRIE MN
55344-3248
US

V. Phone/Fax

Practice location:
  • Phone: 712-264-6391
  • Fax: 952-653-2540
Mailing address:
  • Phone: 952-653-2565
  • Fax: 952-653-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number571
License Number StateIA

VIII. Authorized Official

Name: BRENDA TIEFENTHALER
Title or Position: CEO
Credential:
Phone: 712-264-6391