Provider Demographics
NPI:1467434225
Name:BOONE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:BOONE COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIENITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-432-3140
Mailing Address - Street 1:1015 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4821
Mailing Address - Country:US
Mailing Address - Phone:515-432-3140
Mailing Address - Fax:515-433-8905
Practice Address - Street 1:1015 UNION ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4821
Practice Address - Country:US
Practice Address - Phone:515-433-8470
Practice Address - Fax:515-433-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA161372282N00000X
IA080125H282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
60026OtherBLUE CROSS BLUE SHIELD
IA0600262Medicaid
IA0655712Medicaid
IA200659Medicaid
IA0043182Medicaid
IA0096636Medicaid
IA161372Medicare ID - Type Unspecified
IA0655712Medicaid
IA165558Medicare ID - Type Unspecified
15601Medicare ID - Type UnspecifiedCRNA
IA11695Medicare ID - Type Unspecified
IA200659Medicaid
IA0600262Medicaid