Provider Demographics
NPI:1023154176
Name:ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA
Entity type:Organization
Organization Name:ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4409
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:809 E ELM STREET
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1140
Practice Address - Country:US
Practice Address - Phone:712-642-2794
Practice Address - Fax:402-642-9338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHI HEALTH NEBRASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI1447Medicare PIN
044967Medicare Oscar/Certification
044960Medicare Oscar/Certification
IA44967Medicare PIN
IA44960Medicare PIN
IA41477Medicare PIN
041477Medicare Oscar/Certification