Healthcare Provider Details

I. General information

NPI: 1609129485
Provider Name (Legal Business Name): GRINNELL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 4TH AVE
GRINNELL IA
50112-1898
US

IV. Provider business mailing address

210 4TH AVE
GRINNELL IA
50112-1898
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-7511
  • Fax: 641-236-2403
Mailing address:
  • Phone: 641-236-7511
  • Fax: 641-236-2403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TODD C. LINDEN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 641-236-7511