Delaware County Memorial Hospital
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Manchester, IA
NPI 1982667929 · NPPES record last updated Jan 29, 2008
Key facts
- NPI
- 1982667929
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- DELAWARE COUNTY MEMORIAL HOSPITAL
- Practice address
- 709 W Main St
Manchester, IA 52057-1526 - Phone
- (563) 927-7330
- Fax
- (563) 927-7409
- NPI assigned
- Apr 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Lon Butikofer, RN, PHD
- Title
- Ceo
- Phone
- (563) 927-3232
Owned or controlled facilities with NPI records 8
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 10
Practitioners 186
-
Seth Nicolas Additon, DNP, CRNA
-
Omar H Akhtar, MD
-
Bridget Milene Baker, DNP, ARNP, FNP-BC, P
-
Luke Brunkhorst, D.O.
-
Janice M Budzine, ARNP
-
Jill L Buschmann, ARNP
-
Isaac Albert Butler, CRNA
-
Jennifer Marie Chastek, CRNA
-
Scott J Chastek, CRNA / ARNP
-
Scot R Christiansen, M.D.
-
Sarah Cisco, CRNA
-
Clinton Thomas Cummings, D.O.
-
Blanka Divisova, M.D.
-
Jenny Lynn Duffie, ARNP, FNP-C
-
Derek Manson Dzaboff, ARNP FNP-BC
-
April Ehrler, ARNP
-
Blake Eyberg, MD
-
Katherine Therese Gansen, ARNP, FNP-BC
-
Timothy P Gerst, M.D.
-
Elizabeth M Giedt, CRNA
-
Kellie J Goos, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Regional Medical Center |
Hospital | Operational/Managerial Control | Aug 28, 2013 |
| Regional Medical Center |
Hospital | Operational/Managerial Control | Aug 28, 2013 |
| Regional Family Health Edgewood |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Regional Family Health Hopkinton |
Rural health clinic | Operational/Managerial Control | Apr 1, 2009 |
| Regional Family Health Manchester |
Rural health clinic | Operational/Managerial Control (100%) | Apr 1, 2009 |
| Regional Family Health Strawberry Point |
Rural health clinic | Operational/Managerial Control | Apr 1, 2009 |
| Regional Family Health Winthrop |
Rural health clinic | Operational/Managerial Control (100%) | Aug 1, 1966 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031119000881 | IA | Part B Supplier - Clinic/Group Practice | 2062316375 |
Receives reassigned benefits from 178 practitioners 2 other NPIs on this enrollment Practice locations: Dyersville, IA; Winthrop, IA; Manchester, IA; Strawberry PT, IA |
National Provider Directory
Locations
120 E Charles St
Oelwein, IA 50662
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
709 W Main St
Manchester, IA 52057-1526
Mailing address
709 W Main St
Manchester, IA 52057-1526
Phone (563) 927-7330
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09971 | Other | IA | BCIA |
| 0091637 | Medicaid | IA | |
| 0279307 | Medicaid | IA |
Other names
- Backbone Area Counseling Center
Other providers in Manchester, IA
- Delaware County Memorial Hospital
- Delaware County Memorial Hospital
- Delaware County Memorial Hospital
- Delaware County Memorial Hospital
- Delaware County Memorial Hospital
- Dental Associates of Manchester
- Angela Cae Detmering
- Stefanie Louise Dingbaum
- Blanka Divisova
- Dubuque Internal Medicine PC
All providers in Manchester, IA · Mental Health Clinic/Center (Including Community Mental Health Center) in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.