Provider Demographics
NPI:1407349038
Name:MARENGO MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MARENGO MEMORIAL HOSPITAL
Other - Org Name:COMPASS MEMORIAL HEALTHCARE - PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:GOETTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:319-642-5543
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:319-642-5543
Mailing Address - Fax:319-642-8077
Practice Address - Street 1:300 W MAY ST
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IA
Practice Address - Zip Code:52301-1261
Practice Address - Country:US
Practice Address - Phone:319-642-5543
Practice Address - Fax:319-642-8077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARENGO MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-08
Last Update Date:2020-03-18
Deactivation Date:2019-07-24
Deactivation Code:
Reactivation Date:2020-03-18
Provider Licenses
StateLicense IDTaxonomies
IA9003336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy