Provider Demographics
NPI:1992843353
Name:ADAIR COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ADAIR COUNTY MEMORIAL HOSPITAL
Other - Org Name:ADAIR COUNTY MEMORIAL HOSPITAL WAIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEINZEROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-743-2123
Mailing Address - Street 1:609 SE KENT ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-9454
Mailing Address - Country:US
Mailing Address - Phone:641-743-2123
Mailing Address - Fax:641-743-7294
Practice Address - Street 1:609 SE KENT ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IA
Practice Address - Zip Code:50849-9454
Practice Address - Country:US
Practice Address - Phone:641-743-2123
Practice Address - Fax:641-743-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0114207Medicaid