Provider Demographics
NPI:1689766206
Name:MITCHELL COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MITCHELL COUNTY MEMORIAL HOSPITAL
Other - Org Name:RICEVILLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-732-6003
Mailing Address - Street 1:616 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:IA
Mailing Address - Zip Code:50461-1456
Mailing Address - Country:US
Mailing Address - Phone:641-732-6000
Mailing Address - Fax:641-732-6028
Practice Address - Street 1:109 WESTWARD DR # 6
Practice Address - Street 2:
Practice Address - City:RICEVILLE
Practice Address - State:IA
Practice Address - Zip Code:50466-7550
Practice Address - Country:US
Practice Address - Phone:641-985-2122
Practice Address - Fax:641-985-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0635037Medicaid
IA15225Medicare PIN
IA163497Medicare Oscar/Certification