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  7. NPI Record 1639686512

FORT MADISON COMMUNITY HOSPITAL HOSPICE
Complete NPI Record 1639686512
Hospice Care, Community Based in Fort Madison, IA

NPI Status: Active since January 02, 2018

Contact Information

5445 AVENUE O
FORT MADISON, IA
ZIP 52627
Phone: (319) 376-2166
Fax: (319) 376-2167

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Authorized Official Last Name
  23. Authorized Official First Name
  24. Authorized Official Middle Name
  25. Authorized Official Title or Position
  26. Authorized Official Telephone Number
  27. Healthcare Provider Taxonomy Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Is Organization Subpart
  30. Parent Organization LBN
  31. Parent Organization TIN
  32. Authorized Official Name Prefix Text
  33. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1639686512. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1639686512
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: FORT MADISON COMMUNITY HOSPITAL HOSPICE
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: PO BOX 174
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: FORT MADISON
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: IA
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 526270174
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3193762166
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 5445 AVENUE O
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: FORT MADISON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: IA
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 526279611
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3193762166
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3193762167
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 1/2/2018
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 5/21/2020
The date that a record was last updated or changed.
Authorized Official Last Name: BURCHETT
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: SHELBY
The first name of the authorized official.
Authorized Official Middle Name: L
The middle name of the authorized official.
Authorized Official Title or Position: CEO
The title or position of the authorized official.
Authorized Official Telephone Number: 3193762124
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 251G00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: Y
Parent Organization LBN: FORT MADISON COMMUNITY HOSPITAL
Parent Organization TIN: UNAVAIL
Authorized Official Name Prefix Text: MS.
NPI Certification Date: 5/21/2020