Provider Demographics
NPI:1639686512
Name:FORT MADISON COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:FORT MADISON COMMUNITY HOSPITAL
Other - Org Name:FORT MADISON COMMUNITY HOSPITAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-376-2124
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-0174
Mailing Address - Country:US
Mailing Address - Phone:319-376-2166
Mailing Address - Fax:
Practice Address - Street 1:5445 AVENUE O
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-9611
Practice Address - Country:US
Practice Address - Phone:319-376-2166
Practice Address - Fax:319-376-2167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT MADISON COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-02
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based