Provider Demographics
NPI:1457448755
Name:JENNIE EDMUNDSON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JENNIE EDMUNDSON MEMORIAL HOSPITAL
Other - Org Name:METHODIST JENNIE EDMUNDSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BAUMERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-396-6064
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:933 E PIERCE ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4626
Practice Address - Country:US
Practice Address - Phone:712-396-6000
Practice Address - Fax:712-396-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA780039H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600478Medicaid
IA60047OtherWELLMARK
IA5000005OtherUHC
IA5000005OtherUHC
IA=========OtherTRICARE
IA160047Medicare Oscar/Certification