Provider Demographics
NPI:1972617611
Name:GRINNELL FAMILY CARE PC
Entity type:Organization
Organization Name:GRINNELL FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RISTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-236-7524
Mailing Address - Street 1:217 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1895
Mailing Address - Country:US
Mailing Address - Phone:641-236-7524
Mailing Address - Fax:641-236-7944
Practice Address - Street 1:217 4TH AVE W
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1895
Practice Address - Country:US
Practice Address - Phone:641-236-7524
Practice Address - Fax:641-236-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0120006Medicaid
IA0120006Medicaid