Provider Demographics
NPI:1770652570
Name:VAN BUREN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:VAN BUREN COUNTY HOSPITAL
Other - Org Name:STOCKPORT RURAL HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHNEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-293-3171
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:304 FRANKLIN STREET
Mailing Address - City:KEOSAUQUA
Mailing Address - State:IA
Mailing Address - Zip Code:52565-0070
Mailing Address - Country:US
Mailing Address - Phone:319-293-3171
Mailing Address - Fax:319-293-3473
Practice Address - Street 1:111 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:STOCKPORT
Practice Address - State:IA
Practice Address - Zip Code:52651
Practice Address - Country:US
Practice Address - Phone:319-796-2203
Practice Address - Fax:319-796-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA890026H261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0639955Medicaid
IA163995Medicare Oscar/Certification