Provider Demographics
NPI:1942385679
Name:BOONE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:BOONE COUNTY HOSPITAL
Other - Org Name:BOONE COUNTY HOSPITAL ER GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIENITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-432-3140
Mailing Address - Street 1:1015 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4821
Mailing Address - Country:US
Mailing Address - Phone:515-432-3140
Mailing Address - Fax:515-433-8905
Practice Address - Street 1:1015 UNION ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4821
Practice Address - Country:US
Practice Address - Phone:515-432-3140
Practice Address - Fax:515-433-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20065Medicare ID - Type Unspecified