Provider Demographics
NPI:1093306425
Name:VETERANS MEMORIAL HOSPITAL CITY OF WAUKON IA
Entity Type:Organization
Organization Name:VETERANS MEMORIAL HOSPITAL CITY OF WAUKON IA
Other - Org Name:VMH MEDICAL CLINIC WAUKON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-568-3411
Mailing Address - Street 1:40 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-2022
Mailing Address - Country:US
Mailing Address - Phone:563-568-3411
Mailing Address - Fax:563-568-6139
Practice Address - Street 1:105 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-1735
Practice Address - Country:US
Practice Address - Phone:563-568-3411
Practice Address - Fax:563-568-5699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VETERANS MEMORIAL HOSPITAL CITY OF WAUKON IA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-28
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600239Medicaid