Provider Demographics
NPI:1265479323
Name:ORANGE CITY MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:ORANGE CITY MUNICIPAL HOSPITAL
Other - Org Name:NORTHWEST SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTHMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-737-4984
Mailing Address - Street 1:1000 LINCOLN CIRCLE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1862
Mailing Address - Country:US
Mailing Address - Phone:712-737-5317
Mailing Address - Fax:712-737-5318
Practice Address - Street 1:1000 LINCOLN CIRCLE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1862
Practice Address - Country:US
Practice Address - Phone:712-737-5317
Practice Address - Fax:712-737-5318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORANGE CITY MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0726091Medicaid
IAI14572Medicare ID - Type Unspecified
IA0726091Medicaid