Organization Name: | MARENGO MEMORIAL HOSPITAL |
NPI Number: | 1457368870 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FADI YACOUB (MEDICAL DIRECTOR) |
Mailing Address: | 300 W May St Marengo |
State: | IA US |
Postal Code: | 523011261 |
Phone Number: | 3196428052 |
Fax Number: | 3196428007 |
NPI Enumeration Date: | 08/01/2006 |
NPI Last Update Date: | 01/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | 480154H |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |