Provider Demographics
NPI:1467887398
Name:MARY GREELEY MEDICAL CENTER
Entity Type:Organization
Organization Name:MARY GREELEY MEDICAL CENTER
Other - Org Name:STORY COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-239-2139
Mailing Address - Street 1:1111 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5745
Mailing Address - Country:US
Mailing Address - Phone:515-239-2011
Mailing Address - Fax:515-239-2060
Practice Address - Street 1:1114 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5739
Practice Address - Country:US
Practice Address - Phone:515-239-6730
Practice Address - Fax:515-233-7597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA850040H251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA167024Medicare Oscar/Certification