Provider Demographics
NPI: | 1821413667 |
---|---|
Name: | DAVIS COUNTY HOSPITAL |
Entity Type: | Organization |
Organization Name: | DAVIS COUNTY HOSPITAL |
Other - Org Name: | DAVIS COUNTY MEDICAL ASSOCIATES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | KENDRA |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | WARNING |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 641-664-2145 |
Mailing Address - Street 1: | 509 N MADISON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | BLOOMFIELD |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52537-1271 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 641-664-2145 |
Mailing Address - Fax: | 641-664-1669 |
Practice Address - Street 1: | 509 N MADISON ST |
Practice Address - Street 2: | STE 100 |
Practice Address - City: | BLOOMFIELD |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52537-1271 |
Practice Address - Country: | US |
Practice Address - Phone: | 641-664-3832 |
Practice Address - Fax: | 641-664-1669 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | DAVIS COUNTY HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2014-03-04 |
Last Update Date: | 2020-10-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR1300X | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |