MEDICARE: STEWART MEMORIAL COMMUNITY HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207Q00000X	Family Medicine Physician
2	363A00000X	Physician Assistant
3	1041C0700X	Clinical Social Worker
4	363L00000X	Nurse Practitioner
5	261QR1300X	Rural Health Clinic/Center	IA

General Provider Information

NPI Number	:	1285652909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEWART MEMORIAL COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	1301 W MAIN ST
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449-1585
Country	:	US
Telephone Number	:	712-464-3171
Fax Number	:	712-464-3269

Provider Business Practice Location Address
First Line	:	1351 W MAIN ST
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449-1585
Country	:	US
Telephone Number	:	712-464-7907
Fax Number	:	712-464-7412

Authorized Official
Title or Position	:	CFO
Name	:	JAMES L HENKENIUS
Credential	:
Telephone Number	:	712-464-4200

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	06/17/2026

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