Provider Demographics
NPI:1811039886
Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Other - Org Name:REGIONAL FAMILY HEALTH-STRAWBERRY POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LON
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTIKOFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-927-7308
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:709 W MAIN ST
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-0359
Mailing Address - Country:US
Mailing Address - Phone:563-927-7777
Mailing Address - Fax:563-927-7518
Practice Address - Street 1:111 E MISSION ST
Practice Address - Street 2:
Practice Address - City:STRAWBERRY POINT
Practice Address - State:IA
Practice Address - Zip Code:52076
Practice Address - Country:US
Practice Address - Phone:563-933-7720
Practice Address - Fax:563-933-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
421158372OtherUNITED HEALTHCARE
52076B001OtherTRICARE
52057A001OtherTRICARE
IA0056986Medicaid
IA0166546Medicaid
IA2166546Medicaid
52076A001OtherTRICARE
421158372OtherMIDLAND CHOICE
27553OtherBLUE SHIELD STRAWBERRY PT
IN0638627Medicaid
52057B001OtherTRICARE
55409OtherBLUE SHIELD MANCHESTER
IA0166546Medicaid
IN0638627Medicaid
52076B001OtherTRICARE