Provider Demographics
NPI:1629226832
Name:GREENE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:GREENE COUNTY MEDICAL CENTER
Other - Org Name:ADVANCED WOMEN'S CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANDERLINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-386-2114
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:1000 W LINCOLNWAY ST
Practice Address - Street 2:SUITE AWC
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1645
Practice Address - Country:US
Practice Address - Phone:515-386-2240
Practice Address - Fax:515-386-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1477Medicare PIN