Provider Demographics
NPI:1053368191
Name:MARENGO MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MARENGO MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOETTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-642-5543
Mailing Address - Street 1:300 W MAY ST
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IA
Mailing Address - Zip Code:52301-1261
Mailing Address - Country:US
Mailing Address - Phone:319-642-5543
Mailing Address - Fax:319-642-8007
Practice Address - Street 1:300 W MAY ST
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IA
Practice Address - Zip Code:52301-1261
Practice Address - Country:US
Practice Address - Phone:319-642-5543
Practice Address - Fax:319-642-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15389OtherPHYSICIAN GROUP MEDICARE#
IA15389OtherPHYSICIAN GROUP BCBS #
IA0153890Medicaid
IA0164533Medicaid
IA60073OtherHOSPITAL BCBS NUMBER
IA0600734Medicaid
IA0164533Medicaid