Provider Demographics
NPI:1841786951
Name:GREAT RIVER PHYSICIANS AND CLINICS INC
Entity Type:Organization
Organization Name:GREAT RIVER PHYSICIANS AND CLINICS INC
Other - Org Name:FAMILY PLANNING OF SOUTHEAST IOWA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-768-3471
Mailing Address - Street 1:1221 S GEAR AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1679
Mailing Address - Country:US
Mailing Address - Phone:319-768-3471
Mailing Address - Fax:319-768-3266
Practice Address - Street 1:801 S ROOSEVELT AVE STE C
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1691
Practice Address - Country:US
Practice Address - Phone:319-768-1225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical