Provider Demographics
NPI:1255657466
Name:ALLEN MEMORIAL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:ALLEN MEMORIAL HOSPITAL CORPORATION
Other - Org Name:ALLEN MEDICAL EQUIPMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-235-3987
Mailing Address - Street 1:1825 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1916
Mailing Address - Country:US
Mailing Address - Phone:319-235-5285
Mailing Address - Fax:319-235-3503
Practice Address - Street 1:1717 W RIDGEWAY AVE
Practice Address - Street 2:SUITE 50A
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4543
Practice Address - Country:US
Practice Address - Phone:319-833-6050
Practice Address - Fax:319-833-6051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-13
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1871678318OtherALLEN MEDICAL EQUIPMENT PARENT SITE NPI
IA0128058Medicaid
1015900001Medicare UPIN