Provider Demographics
NPI: | 1235779851 |
---|---|
Name: | MARENGO MEMORIAL HOSPITAL |
Entity Type: | Organization |
Organization Name: | MARENGO MEMORIAL HOSPITAL |
Other - Org Name: | NORTH ENGLISH FAMILY MEDICAL CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BARRY |
Authorized Official - Middle Name: | G |
Authorized Official - Last Name: | GOETTSCH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 319-642-8160 |
Mailing Address - Street 1: | 300 W MAY ST |
Mailing Address - Street 2: | |
Mailing Address - City: | MARENGO |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52301-1261 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 319-642-8160 |
Mailing Address - Fax: | 319-642-8069 |
Practice Address - Street 1: | 402 S WALNUT ST |
Practice Address - Street 2: | |
Practice Address - City: | NORTH ENGLISH |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52316-9559 |
Practice Address - Country: | US |
Practice Address - Phone: | 319-664-3391 |
Practice Address - Fax: | 319-664-3392 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MARENGO MEMORIAL HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2020-01-11 |
Last Update Date: | 2020-02-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |