Provider Demographics
NPI:1336574946
Name:GREENE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:GREENE COUNTY MEDICAL CENTER
Other - Org Name:GCMC-CRNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANDERLINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-386-2114
Mailing Address - Street 1:1000 W LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-1645
Mailing Address - Country:US
Mailing Address - Phone:515-386-2114
Mailing Address - Fax:515-386-3695
Practice Address - Street 1:1000 W LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1645
Practice Address - Country:US
Practice Address - Phone:515-386-2114
Practice Address - Fax:515-386-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty