Provider Demographics
NPI:1467458877
Name:GREATER REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GREATER REGIONAL MEDICAL CENTER
Other - Org Name:GREATER REGIONAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:641-782-3515
Mailing Address - Street 1:1715 W PRAIRIE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1325
Mailing Address - Country:US
Mailing Address - Phone:641-782-3528
Mailing Address - Fax:641-782-3541
Practice Address - Street 1:1715 W PRAIRIE ST
Practice Address - Street 2:SUITE A
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-1325
Practice Address - Country:US
Practice Address - Phone:641-782-3528
Practice Address - Fax:641-782-3541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-22
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA67065OtherHOME CARE BLUE CROSS
IA0670653Medicaid
IAF440OtherMIDLANDS CHOICE
IA0670653Medicaid