Healthcare Provider Details

I. General information

NPI: 1063364149
Provider Name (Legal Business Name): MARENGO MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 8TH AVE UNIT 3
WELLMAN IA
52356-4708
US

IV. Provider business mailing address

300 W MAY ST
MARENGO IA
52301-1261
US

V. Phone/Fax

Practice location:
  • Phone: 319-646-6100
  • Fax:
Mailing address:
  • Phone: 319-642-8160
  • Fax: 319-642-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BARRY G GOETTSCH
Title or Position: CEO
Credential:
Phone: 319-642-8160