Basic Information
| Provider Information | |||||||||
| NPI: | 1093300048 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CASS COUNTY MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ATLANTIC MEDICAL CENTER - RAPID CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | ATLANTIC | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500221936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122433250 | ||||||||
| FaxNumber: | 7122437587 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 E 10TH ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIC | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500221936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122432850 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2021 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | STANGL | ||||||||
| AuthorizedOfficialFirstName: | ABBEY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7122433250 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CASS COUNTY MEMORIAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.