Provider Demographics
NPI:1457427999
Name:GRINNELL REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:GRINNELL REGIONAL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-236-2913
Mailing Address - Street 1:302 SOUTH PARK ST
Mailing Address - Street 2:
Mailing Address - City:NEW SHARON
Mailing Address - State:IA
Mailing Address - Zip Code:50207
Mailing Address - Country:US
Mailing Address - Phone:641-637-4046
Mailing Address - Fax:
Practice Address - Street 1:302 SOUTH PARK ST
Practice Address - Street 2:
Practice Address - City:NEW SHARON
Practice Address - State:IA
Practice Address - Zip Code:50207
Practice Address - Country:US
Practice Address - Phone:641-637-4046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRINNELL REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0685123Medicaid
IA0685123Medicaid