Provider Demographics
NPI:1679329395
Name:SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-768-3268
Mailing Address - Street 1:1223 S GEAR AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1690
Mailing Address - Country:US
Mailing Address - Phone:319-768-3971
Mailing Address - Fax:
Practice Address - Street 1:1223 S GEAR AVE STE 103
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1690
Practice Address - Country:US
Practice Address - Phone:319-768-3971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy