Provider Demographics
NPI:1720154263
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:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-236-2919
Mailing Address - Street 1:709 2ND ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:IA
Mailing Address - Zip Code:52347-7709
Mailing Address - Country:US
Mailing Address - Phone:319-647-7511
Mailing Address - Fax:319-647-7521
Practice Address - Street 1:709 2ND ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:IA
Practice Address - Zip Code:52347-7709
Practice Address - Country:US
Practice Address - Phone:319-647-7511
Practice Address - Fax:319-647-7521
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:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0685107Medicaid
IA0685107Medicaid