Provider Demographics
NPI:1982691002
Name:HENRY COUNTY SOLDIERS' AND SAILORS' MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HENRY COUNTY SOLDIERS' AND SAILORS' MEMORIAL HOSPITAL
Other - Org Name:HENRY COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-385-6716
Mailing Address - Street 1:407 S WHITE ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2263
Mailing Address - Country:US
Mailing Address - Phone:319-385-3141
Mailing Address - Fax:319-385-6571
Practice Address - Street 1:407 S WHITE ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2263
Practice Address - Country:US
Practice Address - Phone:319-385-3141
Practice Address - Fax:319-385-6571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY COUNTY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-04
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA440047H273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA65147OtherWELLMARK BC OF IA
IA0801829Medicaid
IA0801829Medicaid