1275048977 NPI number — GREATER REGIONAL MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275048977 NPI number — GREATER REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER 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:
Provider Other Organization Name Type Code:
6
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:
1275048977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 W TOWNLINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50801-1054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-782-7091
Provider Business Mailing Address Fax Number:
641-782-3830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 DAVIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORNING
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50841-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-322-4431
Provider Business Practice Location Address Fax Number:
641-322-5052
Provider Enumeration Date:
12/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MCCUTCHAN
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
641-782-3899

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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