Healthcare Provider Details

I. General information

NPI: 1083258230
Provider Name (Legal Business Name): VIRGINIA GAY HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARDINAL AVE
ATKINS IA
52206-4700
US

IV. Provider business mailing address

502 N 9TH AVE
VINTON IA
52349-2299
US

V. Phone/Fax

Practice location:
  • Phone: 319-446-7806
  • Fax:
Mailing address:
  • Phone: 319-472-6200
  • Fax: 319-472-6340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BARRY DIETSCH
Title or Position: CFO
Credential:
Phone: 319-472-6255