Provider Demographics
NPI:1114012085
Name:GRUNDY COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:GRUNDY COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZINKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-824-5082
Mailing Address - Street 1:201 E J AVE
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-2096
Mailing Address - Country:US
Mailing Address - Phone:319-824-5421
Mailing Address - Fax:319-824-6291
Practice Address - Street 1:201 E J AVE
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-2096
Practice Address - Country:US
Practice Address - Phone:319-824-5421
Practice Address - Fax:319-824-6291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRUNDY COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA14194Medicare PIN