Provider Demographics
NPI:1346353323
Name:GREATER REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GREATER REGIONAL MEDICAL CENTER
Other - Org Name:LENOX MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCUTCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-782-3899
Mailing Address - Street 1:1700 W TOWNLINE ST
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1054
Mailing Address - Country:US
Mailing Address - Phone:641-782-7091
Mailing Address - Fax:641-782-3830
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:IA
Practice Address - Zip Code:50851-1240
Practice Address - Country:US
Practice Address - Phone:641-333-4545
Practice Address - Fax:641-333-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0634691Medicaid
IA0634691Medicaid
IA163469Medicare Oscar/Certification