Provider Demographics
NPI:1154474609
Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Other - Org Name:REGIONAL FAMILY HEALTH WINTHROP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTIKOFER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD
Authorized Official - Phone:563-927-7308
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-0359
Mailing Address - Country:US
Mailing Address - Phone:563-927-7457
Mailing Address - Fax:563-927-7557
Practice Address - Street 1:345 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:IA
Practice Address - Zip Code:50682-9759
Practice Address - Country:US
Practice Address - Phone:319-935-3343
Practice Address - Fax:319-935-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA280123H261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0218305Medicaid
IA421213909OtherCOMMERCIAL CARRIERS
IA168554Medicare Oscar/Certification