Provider Demographics
NPI:1558548420
Name:SPENCER MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:SPENCER MUNICIPAL HOSPITAL
Other - Org Name:NURSE PRACTITIONER GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIEFENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-264-6111
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4330
Mailing Address - Country:US
Mailing Address - Phone:712-264-6111
Mailing Address - Fax:712-264-6414
Practice Address - Street 1:2004 OKOBOJI AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351-1271
Practice Address - Country:US
Practice Address - Phone:712-338-2461
Practice Address - Fax:712-262-2310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPENCER MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA210037H363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1601120Medicaid
IACC7610Medicare PIN
IA1601120Medicaid