Healthcare Provider Details

I. General information

NPI: 1275048977
Provider Name (Legal Business Name): GREATER REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 DAVIS AVE
CORNING IA
50841-1419
US

IV. Provider business mailing address

1700 W TOWNLINE ST
CRESTON IA
50801-1054
US

V. Phone/Fax

Practice location:
  • Phone: 641-322-4431
  • Fax: 641-322-5052
Mailing address:
  • Phone: 641-782-7091
  • Fax: 641-782-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW L MCCUTCHAN
Title or Position: CFO
Credential:
Phone: 641-782-3899