Provider Demographics
NPI:1760479554
Name:SPENCER MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:SPENCER MUNICIPAL HOSPITAL
Other - Org Name:WARNER DIALYSIS CENTER- SPIRIT LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIEFENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-264-6111
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4330
Mailing Address - Country:US
Mailing Address - Phone:712-264-6111
Mailing Address - Fax:712-264-6404
Practice Address - Street 1:3150 18TH ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7468
Practice Address - Country:US
Practice Address - Phone:712-336-2910
Practice Address - Fax:712-336-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37H261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0601120Medicaid
IA0601120Medicaid