MEDICARE: DELAWARE COUNTY MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871662163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELAWARE COUNTY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	709 W MAIN ST
Second Line	:	PO BOX 359
City	:	MANCHESTER
State	:	IA
Zip	:	52057-1526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 W UNION ST
Second Line	:
City	:	EDGEWOOD
State	:	IA
Zip	:	52042-8187
Country	:	US
Telephone Number	:	563-928-7191
Fax Number	:	563-928-7090

Authorized Official
Title or Position	:	CEO
Name	:	LON BUTIKOFER
Credential	:
Telephone Number	:	563-927-7308

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	12/17/2014

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Directions to “DELAWARE COUNTY MEMORIAL HOSPITAL ” Practice Location

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