Provider Demographics
NPI:1184888265
Name:AUDUBON COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:AUDUBON COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-563-5301
Mailing Address - Street 1:515 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1056
Mailing Address - Country:US
Mailing Address - Phone:712-563-2611
Mailing Address - Fax:712-563-3078
Practice Address - Street 1:107 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:EXIRA
Practice Address - State:IA
Practice Address - Zip Code:50076-7726
Practice Address - Country:US
Practice Address - Phone:712-268-5348
Practice Address - Fax:712-268-2145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUDUBON COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-17
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty