Provider Demographics
NPI:1144289455
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:
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 1:210 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1898
Mailing Address - Country:US
Mailing Address - Phone:641-236-2300
Mailing Address - Fax:641-236-2995
Practice Address - Street 1:306 4TH AVE STE A
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1803
Practice Address - Country:US
Practice Address - Phone:641-236-2418
Practice Address - Fax:641-236-2956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRINNELL REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-23
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251G00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0615419Medicaid
IA61541OtherWELLMARK
IA161541Medicare UPIN