Provider Demographics
NPI:1831162023
Name:MONTGOMERY COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MONTGOMERY COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KLOEWER
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:712-623-7000
Mailing Address - Fax:712-623-7224
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:712-623-7000
Practice Address - Fax:712-623-7224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-09
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA690075H282NC0060X, 314000000X, 275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16Z363Medicare Oscar/Certification