Provider Demographics
NPI:1770571267
Name:MONTGOMERY COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MONTGOMERY COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEFT EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:POHREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-623-7000
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-0498
Mailing Address - Country:US
Mailing Address - Phone:712-623-7194
Mailing Address - Fax:712-623-6469
Practice Address - Street 1:2301 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1305
Practice Address - Country:US
Practice Address - Phone:712-623-7194
Practice Address - Fax:712-623-6469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-10
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0672030Medicaid
IA0672030Medicaid