Provider Demographics
NPI:1871662163
Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DELAWARE COUNTY MEMORIAL HOSPITAL
Other - Org Name:REGIONAL FAMILY HEALTH-EDGEWOOD
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 1:709 W MAIN ST
Mailing Address - Street 2:PO BOX 359
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:702 W UNION ST
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:IA
Practice Address - Zip Code:52042-8187
Practice Address - Country:US
Practice Address - Phone:563-928-7191
Practice Address - Fax:563-928-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0689380Medicaid
IA0689380Medicaid
IA168531Medicare Oscar/Certification