Provider Demographics
NPI:1821170754
Name:HUMBOLDT COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HUMBOLDT COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHAULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-332-4200
Mailing Address - Street 1:1000 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1008
Mailing Address - Country:US
Mailing Address - Phone:515-332-4200
Mailing Address - Fax:515-332-4820
Practice Address - Street 1:1000 15TH ST N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1008
Practice Address - Country:US
Practice Address - Phone:515-332-4200
Practice Address - Fax:515-332-4820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMBOLDT COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA460155H341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0065177Medicaid