Provider Demographics
NPI:1578641593
Name:VAN BUREN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:VAN BUREN COUNTY HOSPITAL
Other - Org Name:FOX RIVER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCENTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-293-3171
Mailing Address - Street 1:304 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:KEOSAUQUA
Mailing Address - State:IA
Mailing Address - Zip Code:52565-1164
Mailing Address - Country:US
Mailing Address - Phone:319-293-3171
Mailing Address - Fax:319-293-3473
Practice Address - Street 1:14983 275 STREET
Practice Address - Street 2:
Practice Address - City:CANTRIL
Practice Address - State:IA
Practice Address - Zip Code:52542-8087
Practice Address - Country:US
Practice Address - Phone:319-397-2300
Practice Address - Fax:319-293-2300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAN BUREN COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0639963Medicaid
IA0639963Medicaid