Basic Information
| Provider Information | |||||||||
| NPI: | 1831162023 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONTGOMERY COUNTY MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 498 | ||||||||
| Address2: | |||||||||
| City: | RED OAK | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515660498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7126237000 | ||||||||
| FaxNumber: | 7126237224 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 EASTERN AVENUE | ||||||||
| Address2: | |||||||||
| City: | RED OAK | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515661305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7126237000 | ||||||||
| FaxNumber: | 7126237224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 12/19/2017 | ||||||||
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| AuthorizedOfficialLastName: | ABERCROMBIE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7126237000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MONTGOMERY COUNTY MEMORIAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 690075H | IA | N | Hospitals | General Acute Care Hospital | Critical Access | 314000000X | 690075H | IA | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 275N00000X | 690075H | IA | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.