Organization
MARENGO MEMORIAL HOSPITAL
Active
Parent organization
MARENGO MEMORIAL HOSPITAL
Other names
Marengo Family Medical Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARENGO MEMORIAL HOSPITAL
Authorized official
BARRY G GOETTSCH (CEO)
(319) 642-5543
Entity
Organization
Contact information
Practice address
300 W MAY ST STE A, MARENGO, IA 52301-1261
(319) 741-6789
(319) 741-6791
Mailing address
300 W MAY ST, MARENGO, IA 52301-1261
(319) 642-8160
(319) 642-8069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02712
IA
207R00000X
Internal Medicine Physician
38260
IA
213E00000X
Podiatrist
00701
IA
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
104766
IA
363LP0200X
Pediatric Nurse Practitioner
109633
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0745489
—
IA
05
—
0761296
—
IA
05
—
0761312
—
IA
05
—
2083113
—
IA
01
—
30218
GROUP BCBS
IA
Enumeration date
12/27/2006
Last updated
01/21/2020
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