Provider Demographics
NPI:1528209483
Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Other - Org Name:REGIONAL FAMILY HEALTH
Other - Org Type:Other Name
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:RN, PHD
Authorized Official - Phone:563-927-7308
Mailing Address - Street 1:709 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1526
Mailing Address - Country:US
Mailing Address - Phone:563-927-3232
Mailing Address - Fax:563-927-7518
Practice Address - Street 1:709 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:IA
Practice Address - Zip Code:52057-1526
Practice Address - Country:US
Practice Address - Phone:563-927-3232
Practice Address - Fax:563-927-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55409OtherBLUE SHIELD, MANCHESTER
IA0166546Medicaid
IACN2597OtherRAILROAD MEDICARE
IA0056986Medicaid
IA13398Medicare PIN
IA55409OtherBLUE SHIELD, MANCHESTER