Provider Demographics
NPI:1972509479
Name:BOONE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:BOONE COUNTY HOSPITAL
Other - Org Name:HOME CARE SERVICES OF BOONE COUNTY HOSPITAL
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 1:105 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4899
Mailing Address - Country:US
Mailing Address - Phone:515-432-1127
Mailing Address - Fax:515-432-0706
Practice Address - Street 1:105 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4899
Practice Address - Country:US
Practice Address - Phone:515-432-1127
Practice Address - Fax:515-432-0706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOONE COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-21
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0062307Medicaid
IA708282OtherBLACK LUNG PROVIDER NUMBE
IA0670349Medicaid
IA25749OtherIOWA HEALTH SOLUTIONS PRO
IA67034OtherBLUE CROSS PROVIDER NUMBE
IA708282OtherBLACK LUNG PROVIDER NUMBE