Provider Demographics
NPI:1609807585
Name:KEOKUK AREA HOSPITAL
Entity Type:Organization
Organization Name:KEOKUK AREA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-526-8772
Mailing Address - Street 1:1600 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-3456
Mailing Address - Country:US
Mailing Address - Phone:319-526-8750
Mailing Address - Fax:319-526-8800
Practice Address - Street 1:1600 MORGAN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3456
Practice Address - Country:US
Practice Address - Phone:319-526-8750
Practice Address - Fax:319-526-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
IA560054H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16U008Medicare Oscar/Certification