Provider Demographics
NPI:1184659153
Name:GUTTENBERG MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:GUTTENBERG MUNICIPAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-252-1121
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:IA
Mailing Address - Zip Code:52052-0550
Mailing Address - Country:US
Mailing Address - Phone:563-252-1121
Mailing Address - Fax:563-252-3120
Practice Address - Street 1:200 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052
Practice Address - Country:US
Practice Address - Phone:536-252-1121
Practice Address - Fax:563-252-3120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUTTENBERG MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
66097OtherWELLMARK
IA0655647Medicaid
66097OtherWELLMARK