Provider Demographics
NPI:1821143850
Name:IASIS GLENWOOD REGIONAL MEDICAL CENTER LP
Entity Type:Organization
Organization Name:IASIS GLENWOOD REGIONAL MEDICAL CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TINNERELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-329-4200
Mailing Address - Street 1:503 MCMILLAN ROAD
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5327
Mailing Address - Country:US
Mailing Address - Phone:318-329-4200
Mailing Address - Fax:318-329-4710
Practice Address - Street 1:503 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5327
Practice Address - Country:US
Practice Address - Phone:318-329-4200
Practice Address - Fax:318-329-4710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IASIS GLENWOOD REGIONAL MEDICAL CENTER LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
195181Medicare Oscar/Certification