NPIMap

Organization Active NPI

Montgomery County Memorial Hospital

Doing business as MCMH Pharmacy

  • Community/Retail Pharmacy
  • Red Oak, IA
National Provider Identifier
1699887547
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MONTGOMERY COUNTY MEMORIAL HOSPITAL
Doing business as
MCMH Pharmacy
Practice address
600 Senate Ave
Red Oak, IA 51566-1283
Phone
(712) 623-1900
NPI assigned
Aug 31, 2006
Last updated
Mar 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Authorized official

Name
Ronald Kloewer
Title
Administrator/Ceo
Phone
(712) 623-7000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

600 Senate Ave
Red Oak, IA 51566-1283

Mailing address

PO Box 498
Red Oak, IA 51566-0498
Phone (712) 623-7000

Other identifiers 2

IdentifierTypeStateIssuer
0220442MedicaidIA
1620788OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • MCMH Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20071017000660 IA Part B Supplier - Mass Immunization (Roster Biller Only) 4082700331 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glenwood, IA; Red Oak, IA
O20240506004753 IA DME Supplier - Pharmacy 9032015805 Practice locations: Red Oak, IA
O20240828003092 IA Part B Supplier - Mass Immunization (Roster Biller Only) 9032015805 Practice locations: Red Oak, IA

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Montogomery Co Mem Hosp11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

501 N 15th St
Clarinda, IA 51632
Phone (712) 260-7552

1206 S Locust St
Glenwood, IA 51534
Phone (712) 527-1200

1400 Senate Ave
Ste 101
Red Oak, IA 51566
Phone (712) 623-6700

1400 Senate Ave
Ste 102
Red Oak, IA 51566
Phone (712) 623-6335

1400 Senate Ave
Ste 107
Red Oak, IA 51566
Phone (712) 623-7275

1600 E Summit St
Red Oak, IA 51566
Phone (712) 623-2500

2221 S 17th St
Lincoln, NE 68502
Phone (402) 483-8555

Practitioners & affiliated clinicians

Practitioners 74

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.

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1699887547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 498",
            "city": "RED OAK",
            "state": "IA",
            "postal_code": "515660498",
            "telephone_number": "712-623-7000",
            "fax_number": "712-623-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SENATE AVE",
            "city": "RED OAK",
            "state": "IA",
            "postal_code": "515661283",
            "telephone_number": "712-623-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A",
        "authorized_official_last_name": "KLOEWER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "712-623-7000"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0220442",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1620788",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCMH Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Red Oak, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.