NPIMap

Organization Active NPI

Audubon County Memorial Hospital

  • Rural Health Clinic/Center
  • Audubon, IA
National Provider Identifier
1851690432
Registry record updated Feb 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
AUDUBON COUNTY MEMORIAL HOSPITAL
Practice address
515 Pacific Ave
Suite 2
Audubon, IA 50025-1056
Phone
(712) 563-2611
Fax
(712) 563-5298
NPI assigned
Mar 22, 2011
Last updated
Feb 27, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
AUDUBON COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2018

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

Authorized official

Name
Ms. Joan S Fancher
Title
Chief Operating Officer
Phone
(712) 563-2611

Specialties & licenses 1

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

Addresses

Primary practice location

515 Pacific Ave
Suite 2
Audubon, IA 50025-1056

Mailing address

515 Pacific Ave
Audubon, IA 50025-1056
Phone (712) 563-2611

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110614000618 IA Part A Provider - Rural Health Clinic 7618866096 Practice locations: Audubon, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851690432. Details of each certification follow.

Rural health clinic certification: CCN 168546

Legal name
AUDUBON COUNTY MEMORIAL HOSPITAL
Doing business as
AUDUBON FAMILY HEALTH CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 1, 2011
Last certification
Sep 14, 2021
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
515 Pacific Ave
Ste 2
Audubon, IA 50025-1056
Related CCNs
161330

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Audubon Co Mem Hospital3 organizations share this tax ID, including this one
Part of
Audubon Co Mem Hospital

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Callen Edward Weispfennig Individual Corporate OfficerCeo Jun 23, 2025 100%
W-2 Managing Employee Jun 23, 2025 100%
Melinda M Alt Individual W-2 Managing EmployeeCfo Jun 6, 2016
Brett Irlmeier Individual Corporate Director Dec 22, 2015
Victoria J Robinson Individual Corporate Director Mar 22, 2016
Marlene Ballou Individual Corporate Director Jun 28, 2011
Mark Kessler Individual Corporate Director Mar 22, 2011

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Audubon County Memorial HospitalAudubon, IA, CCN 16Z330 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Audubon County Memorial HospitalAudubon, IA, CCN 161330 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519689600000",
    "number": "1851690432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 PACIFIC AVE",
            "city": "AUDUBON",
            "state": "IA",
            "postal_code": "500251056",
            "telephone_number": "712-563-2611",
            "fax_number": "712-563-5298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 PACIFIC AVE",
            "address_2": "SUITE 2",
            "city": "AUDUBON",
            "state": "IA",
            "postal_code": "500251056",
            "telephone_number": "712-563-2611",
            "fax_number": "712-563-5298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUDUBON COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AUDUBON COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2011-03-22",
        "last_updated": "2018-02-27",
        "status": "A",
        "authorized_official_last_name": "FANCHER",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "712-563-2611",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Audubon, IA

Sources for this page

Verify at the official NPI Registry.