Provider Demographics
NPI:1043427610
Name:DECATUR COUNTY HOSPITAL
Entity Type:Organization
Organization Name:DECATUR COUNTY HOSPITAL
Other - Org Name:DECATUR COUNTY HOSPITAL- AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-446-4871
Mailing Address - Street 1:1405 NW CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:IA
Mailing Address - Zip Code:50144-1266
Mailing Address - Country:US
Mailing Address - Phone:641-446-4871
Mailing Address - Fax:
Practice Address - Street 1:1405 NW CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:IA
Practice Address - Zip Code:50144-1267
Practice Address - Country:US
Practice Address - Phone:641-446-4871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA270089H341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0115881Medicaid