Healthcare Provider Details

I. General information

NPI: 1396355343
Provider Name (Legal Business Name): GRINNELL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 4TH AVE STE 100, 200, 201 & 300
GRINNELL IA
50112-1898
US

IV. Provider business mailing address

210 4TH AVE
GRINNELL IA
50112-1898
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-2323
  • Fax:
Mailing address:
  • Phone: 641-236-2300
  • Fax: 641-236-2995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID-PAUL CAVAZOS
Title or Position: RURAL PRESIDENT
Credential:
Phone: 641-236-7511