Provider Demographics
NPI:1710926506
Name:ADAIR COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ADAIR COUNTY MEMORIAL HOSPITAL
Other - Org Name:ADAIR COUNTY MEDICAL CLINIC FONTANELLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-743-7234
Mailing Address - Street 1:609 SE KENT ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-9494
Mailing Address - Country:US
Mailing Address - Phone:641-743-2123
Mailing Address - Fax:641-743-7292
Practice Address - Street 1:406 5TH ST
Practice Address - Street 2:
Practice Address - City:FONTANELLE
Practice Address - State:IA
Practice Address - Zip Code:50846-8308
Practice Address - Country:US
Practice Address - Phone:641-745-4300
Practice Address - Fax:641-743-4034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAIR COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA33844OtherBLUE CROSS
IA0685016Medicaid
IA168501Medicare Oscar/Certification