Healthcare Provider Details

I. General information

NPI: 1154474609
Provider Name (Legal Business Name): DELAWARE COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 1ST ST S
WINTHROP IA
50682-9759
US

IV. Provider business mailing address

PO BOX 359
MANCHESTER IA
52057-0359
US

V. Phone/Fax

Practice location:
  • Phone: 319-935-3343
  • Fax: 319-935-3331
Mailing address:
  • Phone: 563-927-7457
  • Fax: 563-927-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number280123H
License Number StateIA

VIII. Authorized Official

Name: DR. LON BUTIKOFER
Title or Position: CEO
Credential: RN, PHD
Phone: 563-927-7308