Provider Demographics
NPI:1235214420
Name:HUMBOLDT COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HUMBOLDT COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLEITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-332-4200
Mailing Address - Street 1:1000 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1008
Mailing Address - Country:US
Mailing Address - Phone:515-332-4200
Mailing Address - Fax:515-332-4820
Practice Address - Street 1:1000 15TH ST N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1008
Practice Address - Country:US
Practice Address - Phone:515-332-4200
Practice Address - Fax:515-332-4820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMBOLDT COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA460155H275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA66152OtherBLUE CROSS SNF
IA0655084Medicaid
IA16Z334Medicare Oscar/Certification