Provider Demographics
NPI:1497824353
Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Other - Org Name:REGIONAL FAMILY HEALTH-HOPKINTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTIKOFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-927-7308
Mailing Address - Street 1:709 W MAIN ST
Mailing Address - Street 2:PO BOX 359
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-0359
Mailing Address - Country:US
Mailing Address - Phone:563-927-3232
Mailing Address - Fax:563-927-7518
Practice Address - Street 1:122 FIRST STREET SW
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:IA
Practice Address - Zip Code:52237
Practice Address - Country:US
Practice Address - Phone:563-926-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0638841Medicaid
IA25789Medicare PIN
IA168529Medicare Oscar/Certification