Provider Demographics
NPI:1003859620
Name:VIRGINIA GAY HOSPITAL, INC
Entity Type:Organization
Organization Name:VIRGINIA GAY HOSPITAL, INC
Other - Org Name:URBANA FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-443-5000
Mailing Address - Street 1:1002 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IA
Mailing Address - Zip Code:52345-9099
Mailing Address - Country:US
Mailing Address - Phone:319-443-5000
Mailing Address - Fax:
Practice Address - Street 1:1002 W MAIN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IA
Practice Address - Zip Code:52345-9099
Practice Address - Country:US
Practice Address - Phone:319-443-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5056994Medicaid
IA163485Medicare Oscar/Certification