Provider Demographics
NPI:1063592582
Name:GREENE COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:GREENE COUNTY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANDERLINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-386-2114
Mailing Address - Street 1:1000 W LINCOLNWAY ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-1645
Mailing Address - Country:US
Mailing Address - Phone:515-386-2114
Mailing Address - Fax:515-386-3695
Practice Address - Street 1:1000 W LINCOLNWAY ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1645
Practice Address - Country:US
Practice Address - Phone:515-386-2114
Practice Address - Fax:515-386-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA670927Medicaid
IA670927Medicaid