Healthcare Provider Details

I. General information

NPI: 1194880112
Provider Name (Legal Business Name): MADISON COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HUTCHINGS ST
WINTERSET IA
50273-2104
US

IV. Provider business mailing address

300 W HUTCHINGS ST
WINTERSET IA
50273-2104
US

V. Phone/Fax

Practice location:
  • Phone: 515-462-2373
  • Fax: 515-462-5213
Mailing address:
  • Phone: 515-462-2373
  • Fax: 515-462-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARCIA L HENDRICKS
Title or Position: CEO
Credential:
Phone: 515-462-2373