Healthcare Provider Details

I. General information

NPI: 1770652570
Provider Name (Legal Business Name): VAN BUREN COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S. MAIN ST.
STOCKPORT IA
52651
US

IV. Provider business mailing address

PO BOX 70 304 FRANKLIN STREET
KEOSAUQUA IA
52565-0070
US

V. Phone/Fax

Practice location:
  • Phone: 319-796-2203
  • Fax: 319-796-2203
Mailing address:
  • Phone: 319-293-3171
  • Fax: 319-293-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number890026H
License Number StateIA

VIII. Authorized Official

Name: MS. LISA W SCHNEDLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 319-293-3171