Provider Demographics
NPI:1386679793
Name:GUTTENBERG MUNICIPAL HOSPITAL
Entity type:Organization
Organization Name:GUTTENBERG MUNICIPAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:563-252-1121
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:IA
Mailing Address - Zip Code:52052-0550
Mailing Address - Country:US
Mailing Address - Phone:563-252-1121
Mailing Address - Fax:563-252-3120
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052
Practice Address - Country:US
Practice Address - Phone:563-252-1121
Practice Address - Fax:563-252-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5000126OtherUNITED HEALTHCARE
IADH0857OtherMEDICARE RR-PALMETTO GBA
IA0474429Medicaid
IA21169OtherWELLMARK-CRNA
IA07244OtherWELLMARK-GSP
IA21169OtherWELLMARK-CRNA
WI000023050Medicare PIN