Provider Demographics
NPI:1902866478
Name:GREAT RIVER WOMEN'S HEALTH
Entity Type:Organization
Organization Name:GREAT RIVER WOMEN'S HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MGR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:319-752-4541
Mailing Address - Street 1:1223 S GEAR AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1682
Mailing Address - Country:US
Mailing Address - Phone:319-752-4541
Mailing Address - Fax:319-752-4541
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:STE 208
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1682
Practice Address - Country:US
Practice Address - Phone:319-752-4541
Practice Address - Fax:319-752-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA51133OtherWELLMARK BCBS
IA0123299Medicaid
IA0123299Medicaid