Healthcare Provider Details

I. General information

NPI: 1639314941
Provider Name (Legal Business Name): MADISON COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HUTCHINGS ST
WINTERSET IA
50273-2109
US

IV. Provider business mailing address

300 W HUTCHINGS ST
WINTERSET IA
50273-2109
US

V. Phone/Fax

Practice location:
  • Phone: 515-462-2373
  • Fax: 515-462-9060
Mailing address:
  • Phone: 515-462-2373
  • Fax: 515-462-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

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