Provider Demographics
NPI:1962436972
Name:GREENE COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:GREENE COUNTY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANDERLINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-386-2114
Mailing Address - Street 1:803 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-1055
Mailing Address - Country:US
Mailing Address - Phone:641-755-2121
Mailing Address - Fax:641-755-2314
Practice Address - Street 1:803 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PANORA
Practice Address - State:IA
Practice Address - Zip Code:50216-1055
Practice Address - Country:US
Practice Address - Phone:641-755-2121
Practice Address - Fax:641-755-2314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0634816Medicaid
IA0634816Medicaid