Provider Demographics
NPI:1578646196
Name:GREAT RIVER ORTHOPAEDIC SURGERY & SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:GREAT RIVER ORTHOPAEDIC SURGERY & SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-752-1700
Mailing Address - Street 1:1225 S GEAR AVE
Mailing Address - Street 2:STE 256
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1691
Mailing Address - Country:US
Mailing Address - Phone:319-752-1700
Mailing Address - Fax:
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:STE 256
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-752-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35185207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1290973Medicaid
IA240008OtherMIDLANDS CHOICE
IADD0905OtherRAILROAD MEDICARE
IA38470OtherBLUE CROSS IOWA
IA1290973Medicaid
IA1290973Medicaid
IA38470OtherBLUE CROSS IOWA