Provider Demographics
NPI:1720673973
Name:GRINNELL REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GRINNELL REGIONAL MEDICAL CENTER
Other - Org Name:UNITYPOINT HEALTH - GRINNELL MONTEZUMA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANCE & OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-236-2300
Mailing Address - Street 1:210 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-1898
Mailing Address - Country:US
Mailing Address - Phone:641-236-2300
Mailing Address - Fax:641-236-2995
Practice Address - Street 1:101 W WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:IA
Practice Address - Zip Code:50171-7739
Practice Address - Country:US
Practice Address - Phone:641-623-5690
Practice Address - Fax:641-623-2229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRINNELL REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-09
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health