Provider Demographics
NPI:1831104611
Name:MADISON COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:MADISON COUNTY MEMORIAL HOSPITAL
Other - Org Name:MADISON COUNTY HEALTH CARE SYSTEM
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:515-462-2373
Mailing Address - Street 1:300 W HUTCHINGS ST
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-2104
Mailing Address - Country:US
Mailing Address - Phone:515-462-2373
Mailing Address - Fax:515-462-5213
Practice Address - Street 1:300 W HUTCHINGS ST
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-2104
Practice Address - Country:US
Practice Address - Phone:515-462-2373
Practice Address - Fax:515-462-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA610113H282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600528Medicaid
IA60052OtherBCBS
IA60052OtherBCBS
IA161326Medicare Oscar/Certification