Provider Demographics
NPI:1346390655
Name:FORT MADISON COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:FORT MADISON COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE, RISK MGR., PATIENT SAFE
Authorized Official - Prefix:MS
Authorized Official - First Name:BARB
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-376-2711
Mailing Address - Street 1:5445 AVENUE O
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-9611
Mailing Address - Country:US
Mailing Address - Phone:319-376-2156
Mailing Address - Fax:319-372-9119
Practice Address - Street 1:5445 AVENUE O
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-9611
Practice Address - Country:US
Practice Address - Phone:319-376-2156
Practice Address - Fax:319-372-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA560087H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190751Medicaid
IA06021OtherBCBS
IA0190751Medicaid