Provider Demographics
NPI:1558442269
Name:ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA
Entity Type:Organization
Organization Name:ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA
Other - Org Name:CHI HEALTH CLINIC LOGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO - CHI HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4420
Mailing Address - Street 1:118 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:IA
Mailing Address - Zip Code:51546-1306
Mailing Address - Country:US
Mailing Address - Phone:712-644-3288
Mailing Address - Fax:712-644-2549
Practice Address - Street 1:118 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:IA
Practice Address - Zip Code:51546-1306
Practice Address - Country:US
Practice Address - Phone:712-644-3288
Practice Address - Fax:712-644-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
163431Medicare Oscar/Certification
163431Medicare ID - Type Unspecified