Provider Demographics
NPI:1043816606
Name:ALLEN MEMORIAL HOSPITAL CORPORATION LAB
Entity type:Organization
Organization Name:ALLEN MEMORIAL HOSPITAL CORPORATION LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DELAGARDELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-824-5421
Mailing Address - Street 1:1825 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1916
Mailing Address - Country:US
Mailing Address - Phone:319-235-3941
Mailing Address - Fax:
Practice Address - Street 1:1825 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-3941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEN MEMORIAL HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory