Provider Demographics
NPI:1790854503
Name:VAN BUREN COUNTY HOSPITAL
Entity Type:Organization
Organization Name:VAN BUREN COUNTY HOSPITAL
Other - Org Name:BIRMINGHAM MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCENTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-293-3171
Mailing Address - Street 1:304 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:KEOSAUQUA
Mailing Address - State:IA
Mailing Address - Zip Code:52565-1164
Mailing Address - Country:US
Mailing Address - Phone:319-293-3171
Mailing Address - Fax:319-293-3473
Practice Address - Street 1:735 NORTH HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:IA
Practice Address - Zip Code:52535-9004
Practice Address - Country:US
Practice Address - Phone:319-498-4370
Practice Address - Fax:319-498-4776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAN BUREN COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0639971Medicaid
IA163997Medicare Oscar/Certification