Provider Demographics
NPI:1881294536
Name:JEFFERSON COUNTY HOSPITAL
Entity type:Organization
Organization Name:JEFFERSON COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:PEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-469-4304
Mailing Address - Street 1:2000 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-9572
Mailing Address - Country:US
Mailing Address - Phone:641-469-4309
Mailing Address - Fax:
Practice Address - Street 1:107 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:IA
Practice Address - Zip Code:52585-9549
Practice Address - Country:US
Practice Address - Phone:641-469-4309
Practice Address - Fax:641-469-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health