Provider Demographics
NPI:1154487544
Name:MITCHELL COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MITCHELL COUNTY MEMORIAL HOSPITAL
Other - Org Name:MITCHELL COUNTY REGIONAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-732-6003
Mailing Address - Street 1:620 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-1456
Mailing Address - Country:US
Mailing Address - Phone:641-732-6000
Mailing Address - Fax:641-732-6025
Practice Address - Street 1:620 N 8TH ST
Practice Address - Street 2:
Practice Address - City:OSAGE
Practice Address - State:IA
Practice Address - Zip Code:50461-1456
Practice Address - Country:US
Practice Address - Phone:641-732-6000
Practice Address - Fax:641-732-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0152256Medicaid
IA15225Medicare PIN
IA0152256Medicaid