NPIMap

Organization Active NPI

Delaware County Memorial Hospital

  • Public Health or Welfare Agency
  • Manchester, IA
National Provider Identifier
1356726475
Registry record updated Jul 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
DELAWARE COUNTY MEMORIAL HOSPITAL
Practice address
613 W Main St
Manchester, IA 52057-1527
Phone
(563) 927-7353
Fax
(563) 927-7520
NPI assigned
Jul 30, 2015
Last updated
Jul 30, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lon Butikofer, RN, PHD
Title
Ceo
Phone
(563) 927-7308

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

613 W Main St
Manchester, IA 52057-1527

Mailing address

709 W Main St
PO Box 359
Manchester, IA 52057-1526
Phone (563) 927-7457

Other names 1

  • DELAWARE COUNTY PUBLIC HEALTH Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151203000389 IA Part B Supplier - Mass Immunization (Roster Biller Only) 2062316375 Practice locations: Manchester, IA

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Delaware Co Mem Hosp ER12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

980 Field of Dreams Way
Dyersville, IA 52040
Phone (563) 875-2147

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Regional Medical CenterManchester, IA, CCN 161343 Hospital Operational/Managerial Control Aug 28, 2013
Regional Medical CenterManchester, IA, CCN 16Z343 Hospital Operational/Managerial Control Aug 28, 2013
Regional Family Health EdgewoodEdgewood, IA, CCN 168531 Rural health clinic Operational/Managerial Control Jan 1, 1966
Regional Family Health HopkintonHopkinton, IA, CCN 168529 Rural health clinic Operational/Managerial Control Apr 1, 2009
Regional Family Health ManchesterManchester, IA, CCN 168530 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2009
Regional Family Health Strawberry PointStrawberry Point, IA, CCN 168528 Rural health clinic Operational/Managerial Control Apr 1, 2009
Regional Family Health WinthropWinthrop, IA, CCN 168554 Rural health clinic Operational/Managerial Control (100%) Aug 1, 1966

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438214400000",
    "number": "1356726475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 W MAIN ST",
            "address_2": "PO BOX 359",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "520571526",
            "telephone_number": "563-927-7457",
            "fax_number": "563-927-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 W MAIN ST",
            "city": "MANCHESTER",
            "state": "IA",
            "postal_code": "520571527",
            "telephone_number": "563-927-7353",
            "fax_number": "563-927-7520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAWARE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-30",
        "last_updated": "2015-07-30",
        "status": "A",
        "authorized_official_last_name": "BUTIKOFER",
        "authorized_official_first_name": "LON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-927-7308",
        "authorized_official_credential": "RN, PHD"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DELAWARE COUNTY PUBLIC HEALTH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Manchester, IA

Sources for this page

Verify at the official NPI Registry.