Provider Demographics
NPI:1790115582
Name:GRINNELL REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GRINNELL REGIONAL MEDICAL CENTER
Other - Org Name:GRINNELL REGIONAL INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:C
Authorized Official - Last Name:LINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-236-7511
Mailing Address - Street 1:210 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1898
Mailing Address - Country:US
Mailing Address - Phone:641-236-2382
Mailing Address - Fax:641-236-2439
Practice Address - Street 1:210 4TH AVE
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-1898
Practice Address - Country:US
Practice Address - Phone:641-236-2382
Practice Address - Fax:641-236-2439
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRINNELL REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-15
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00815Medicare PIN