Healthcare Provider Details

I. General information

NPI: 1942584784
Provider Name (Legal Business Name): ALLEN MEMORIAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 LOGAN AVE
WATERLOO IA
50703-1999
US

IV. Provider business mailing address

1825 LOGAN AVE
WATERLOO IA
50703-1999
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-3606
  • Fax:
Mailing address:
  • Phone: 319-235-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number070034H
License Number StateIA

VIII. Authorized Official

Name: RENEE A RASMUSSEN
Title or Position: CFO
Credential:
Phone: 319-235-3918