1780681379 NPI number — GRINNELL REGIONAL MEDICAL CENTER

Table of content: (NPI 1780681379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780681379 NPI number — GRINNELL REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRINNELL REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRINNELL REGIONAL HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780681379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 4TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRINNELL
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50112-1898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-236-2550
Provider Business Mailing Address Fax Number:
641-236-2599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 4TH AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRINNELL
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50112-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-236-2385
Provider Business Practice Location Address Fax Number:
641-236-2599
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILCOX
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
641-236-2919

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0670620 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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