MONTGOMERY COUNTY MEMORIAL HOSPITAL (NPI# 1790758092) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790758092 |
| Entity Type | Organization |
| Organization Name | MONTGOMERY COUNTY MEMORIAL HOSPITAL |
| Other Organization Name | VILLISCA MEDICAL CLINIC |
| Practice Address |
301 E 4th St Villisca IA 50864-1146 |
| Practice Telephone | 7128264422 |
| Practice Fax Number | 7128262052 |
| Mailing Telephone | 7128264422 |
| Mailing Fax Number | 7128262052 |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | RONNEL K BADERTSCHER (BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 7126237156 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
690075H | IA | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Villisca Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841220597 | Montgomery County Memorial Hospital | Durable Medical Equipment & Medical Supplies | 111 E Washington Ave, Red Oak, IA 51566-2238 | 2006-07-04 |
| 1265405310 | Montgomery County Memorial Hospital | Dietitian, Registered | 2301 Eastern Avenue, Red Oak, IA 51566-1305 | 2006-02-09 |
| 1356314637 | Montgomery County Memorial Hospital | Obstetrics & Gynecology | 1109 Highland Ave, Red Oak, IA 51566-1715 | 2006-02-08 |
| 1376539338 | Montgomery County Memorial Hospital | General Acute Care Hospital | 2301 Eastern Ave, Red Oak, IA 51566-1305 | 2005-09-26 |
| 1558496620 | Montgomery County Memorial Hospital | Dietitian, Registered | 2301 Eastern Ave, Red Oak, IA 51566-0498 | 2007-02-22 |
| 1255447546 | Montgomery County Memorial Hospital | Hospice Care, Community Based | 2301 Eastern Avenue, Red Oak, IA 51566-1305 | 2006-08-21 |
| 1831162023 | Montgomery County Memorial Hospital | General Acute Care Hospital | 2301 Eastern Avenue, Red Oak, IA 51566-1305 | 2006-02-09 |
| 1811960867 | Montgomery County Memorial Hospital | Nurse Anesthetist, Certified Registered | 2301 Eastern Ave, Red Oak, IA 51566-1305 | 2006-02-09 |
| 1770571267 | Montgomery County Memorial Hospital | Home Health | 2301 Eastern Ave, Red Oak, IA 51566-1305 | 2005-10-10 |
| Street Address |
301 E 4TH ST |
| City | VILLISCA |
| State | IA |
| Zip Code | 50864-1146 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093990517 | Denise W Gossett | Clinical Nurse Specialist | 301 E 4th St, Villisca, IA 50864-1146 | 2008-01-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063062867 | Courtney Renee Myers | Massage Therapist | 113 N 3rd Ave, Villisca, IA 50864-1018 | 2019-09-13 |
| 1720078231 | The Evangelical Lutheran Good Samaritan Society | Durable Medical Equipment & Medical Supplies | 202 Central Ave, Villisca, IA 50864-1025 | 2005-10-26 |
| 1417357195 | Jacob Eblen | Specialist/Technologist | 127 W High St, Villisca, IA 50864-1040 | 2014-08-29 |
| 1285781054 | Villisca Community Schools | Local Education Agency (LEA) | 406 E 3rd St, Villisca, IA 50864-1137 | 2007-01-04 |
| 1255376554 | City of Villisca | Ambulance | 207 S 3rd Ave, Villisca, IA 50864-1142 | 2006-06-19 |
| 1477592343 | Clarinda Regional Health Center | Clinic/Center | 309 S 5th Ave, Villisca, IA 50864-1160 | 2006-06-06 |
| 1538288352 | Villisca Family Health Center | Clinic/Center | 309 S 5th Ave, Villisca, IA 50864-1160 | 2007-03-29 |
| 1013083773 | Honeyman Drug Stoner Drug Co Inc | Durable Medical Equipment & Medical Supplies | 408 S 3rd Ave, Villisca, IA 50864-1213 | 2006-11-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063062867 | Courtney Renee Myers | Massage Therapist | 113 N 3rd Ave, Villisca, IA 50864-1018 | 2019-09-13 |
| 1417357195 | Jacob Eblen | Specialist/Technologist | 127 W High St, Villisca, IA 50864-1040 | 2014-08-29 |
| 1285781054 | Villisca Community Schools | Local Education Agency (LEA) | 406 E 3rd St, Villisca, IA 50864-1137 | 2007-01-04 |
| 1013083773 | Honeyman Drug Stoner Drug Co Inc | Durable Medical Equipment & Medical Supplies | 408 S 3rd Ave, Villisca, IA 50864-1213 | 2006-11-27 |
| 1255376554 | City of Villisca | Ambulance | 207 S 3rd Ave, Villisca, IA 50864-1142 | 2006-06-19 |
| 1477592343 | Clarinda Regional Health Center | Clinic/Center | 309 S 5th Ave, Villisca, IA 50864-1160 | 2006-06-06 |
| 1720078231 | The Evangelical Lutheran Good Samaritan Society | Durable Medical Equipment & Medical Supplies | 202 Central Ave, Villisca, IA 50864-1025 | 2005-10-26 |
| 1538288352 | Villisca Family Health Center | Clinic/Center | 309 S 5th Ave, Villisca, IA 50864-1160 | 2007-03-29 |
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457950032 | Mary Christine Pope | Nurse Practitioner | 1023 E Avenue, Scranton, IA 51462-7520 | 2020-10-23 |
| 1922607936 | Alisse Anna Diers | Nurse Practitioner | 346 2nd Ave Sw # 303, Cedar Rapids, IA 52404-2045 | 2020-10-21 |
| 1043818941 | Leslie Brooke Charleville | Nurse Practitioner | 10001 95th Ave, Indianola, IA 50125-7181 | 2020-10-13 |
| 1467050674 | Sarah Schoner | Nurse Practitioner | 801 East Grand Avenue, Mount Pleasant, IA 52641 | 2020-10-12 |
| 1669088654 | Jinxia Peng | Nurse Practitioner | 9823 Biscayne Dr, Johnston, IA 50131-3002 | 2020-09-16 |
| 1093320392 | Ryan Michael Winder | Nurse Practitioner | 615 A Ave Se, Mount Vernon, IA 52314-1532 | 2020-09-14 |
| 1659986594 | Matthew John Garred | Nurse Practitioner | 420 Driftwood Ct, Sioux City, IA 51104-2200 | 2020-09-08 |
| 1699389882 | Mary Ann Shaw | Nurse Practitioner | 207 W Main Ave, Rockford, IA 50468-1213 | 2020-09-04 |
| 1588277404 | Alyson Seamer | Nurse Practitioner | 8455 Ridgeview Dr, Des Moines, IA 50320-6954 | 2020-08-29 |
| 1114530045 | Brittany Ann Enlow | Nurse Practitioner | 620 E Washington St, Washington, IA 52353-2031 | 2020-08-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.