MEDICARE: GRINNELL REGIONAL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457427999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRINNELL REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	302 SOUTH PARK ST
Second Line	:
City	:	NEW SHARON
State	:	IA
Zip	:	50207
Country	:	US
Telephone Number	:	641-637-4046
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 SOUTH PARK ST
Second Line	:
City	:	NEW SHARON
State	:	IA
Zip	:	50207
Country	:	US
Telephone Number	:	641-637-4046
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PHYSICIAN SERVICES
Name	:	AMY MORROW
Credential	:
Telephone Number	:	641-236-2913

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	06/15/2010

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