Provider Demographics
NPI:1427032457
Name:KEOKUK AREA HOSPITAL
Entity Type:Organization
Organization Name:KEOKUK AREA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-526-8772
Mailing Address - Street 1:1600 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-3456
Mailing Address - Country:US
Mailing Address - Phone:319-524-7150
Mailing Address - Fax:319-526-8800
Practice Address - Street 1:1600 MORGAN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3456
Practice Address - Country:US
Practice Address - Phone:319-524-7150
Practice Address - Fax:319-526-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA560054H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA60008OtherBLUE CROSS
IA6T008OtherBLUE CROSS BLUE SHIELD
IA0192658Medicaid
IA0457267Medicaid
MO010673903Medicaid
MO100673904Medicaid
IAA001203OtherCHAMPUS
MO10IA420OtherBLUE CROSS
IL821OtherBLUE CROSS
IA0600080Medicaid
IA48990OtherBLUE CROSS BLUE SHIELD
IA0600080Medicaid
IA6T008OtherBLUE CROSS BLUE SHIELD
IA160008Medicare ID - Type Unspecified
IA48990Medicare ID - Type Unspecified
MO100673904Medicaid
IA0600080Medicaid