Provider Demographics
NPI:1083258230
Name:VIRGINIA GAY HOSPITAL, INC.
Entity Type:Organization
Organization Name:VIRGINIA GAY HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-472-6255
Mailing Address - Street 1:502 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-2299
Mailing Address - Country:US
Mailing Address - Phone:319-472-6200
Mailing Address - Fax:319-472-6340
Practice Address - Street 1:401 CARDINAL AVE
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:IA
Practice Address - Zip Code:52206-4700
Practice Address - Country:US
Practice Address - Phone:319-446-7806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA GAY HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty