NPIMap

Organization Active NPI

Van Buren County Hospital

  • Rural Health Clinic/Center
  • Keosauqua, IA
National Provider Identifier
1831260280
Registry record updated Nov 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
VAN BUREN COUNTY HOSPITAL
Practice address
304 Franklin St
Keosauqua, IA 52565-1164
Phone
(319) 293-3171
Fax
(319) 293-6241
NPI assigned
Nov 9, 2006
Organization subpart
Yes
Parent organization
VAN BUREN COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2013

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

Authorized official

Name
Ms. Kara M. McEntee
Title
Cfo
Phone
(319) 293-3171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

304 Franklin St
Keosauqua, IA 52565-1164

Mailing address

304 Franklin St
Keosauqua, IA 52565-1164
Phone (319) 293-3171

Other identifiers 1

IdentifierTypeStateIssuer
0634535MedicaidIA

Other names 1

  • Keosauqua Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050214000873 IA Part A Provider - Rural Health Clinic 7214829530 Practice locations: Keosauqua, IA

Rural health clinic certification: CCN 163453

Legal name
VAN BUREN COUNTY HOSPITAL
Doing business as
KEOSAUQUA MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 1996
Last certification
Aug 16, 2023
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
304 Franklin St
Keosauqua, IA 52565-1164

Other NPIs with the same Medicare PAC ID 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0387220Keosauqua Medical Clinic304 Franklin Street, Keosauqua, IA 52565Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Van Buren County Hospital8 organizations share this tax ID, including this one
Part of
Van Buren County Hospital

Other organizations with this tax ID 7

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

Locations

604 1st St
Bonaparte, IA 52620

206 N 4th St
Farmington, IA 52626

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kara McEntee Individual Corporate OfficerCfo Jul 31, 2013
W-2 Managing EmployeeCfo Apr 19, 2007
Operational/Managerial ControlCfo Apr 19, 2007
Benjamin D Sherod Individual Corporate Officer Jan 28, 2013
Corporate Director Oct 22, 2010
Patricia Lou Tucker Individual Corporate Director Dec 31, 2022
Mindy B Cormier Individual W-2 Managing EmployeeClinic Manager Sep 6, 2018
Operational/Managerial ControlClinic Manager Sep 6, 2018
Dana R Brecount Individual W-2 Managing EmployeeMedical Director Jul 1, 2017
Operational/Managerial ControlMedical Director Jul 1, 2017
Jeanne Erickson Individual Corporate Director Jan 1, 1997
Ann McBride Individual Corporate Officer Feb 23, 2021
Corporate Director May 26, 2020
Garen Carpenter Individual Contracted Managing EmployeeCeo Aug 3, 2020
Corporate OfficerCeo Aug 3, 2020
Operational/Managerial ControlCeo Aug 3, 2020
Quenton Dodson Individual Corporate Officer Feb 27, 2018
Corporate Director Mar 29, 2016
Mercy Health Network Inc Organization, Clive, IA Corporation, Management services company, Non-profit Operational/Managerial Control Mar 1, 2020
Michael Thomas Individual Corporate Director Jan 1, 1998
Heather a Charbonneau Individual Corporate Officer Feb 27, 2018
Corporate Director Nov 28, 2017
Kasha Kite Individual W-2 Managing EmployeeCno Feb 6, 2019
Operational/Managerial ControlCno Feb 6, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 98

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 98

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384387200000",
    "number": "1831260280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 FRANKLIN ST",
            "city": "KEOSAUQUA",
            "state": "IA",
            "postal_code": "525651164",
            "telephone_number": "319-293-3171",
            "fax_number": "319-293-6241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 FRANKLIN ST",
            "city": "KEOSAUQUA",
            "state": "IA",
            "postal_code": "525651164",
            "telephone_number": "319-293-3171",
            "fax_number": "319-293-6241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAN BUREN COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VAN BUREN COUNTY HOSPITAL",
        "enumeration_date": "2006-11-09",
        "last_updated": "2013-11-14",
        "status": "A",
        "authorized_official_last_name": "MCENTEE",
        "authorized_official_first_name": "KARA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "319-293-3171",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0634535",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keosauqua Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Keosauqua, IA

Sources for this page

Verify at the official NPI Registry.