Provider Demographics
NPI:1649297326
Name:GREAT RIVER ONCOLOGY, P.C.
Entity type:Organization
Organization Name:GREAT RIVER ONCOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROHINI
Authorized Official - Middle Name:
Authorized Official - Last Name:REGANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-753-1220
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-0633
Mailing Address - Country:US
Mailing Address - Phone:319-753-1220
Mailing Address - Fax:319-753-5464
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:SUITE 152
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-753-1220
Practice Address - Fax:319-753-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0274860Medicaid
IA08894OtherBCBS GROUP PROVIDER NUMBE
IA08894OtherBCBS GROUP PROVIDER NUMBE