Healthcare Provider Details

I. General information

NPI: 1689211146
Provider Name (Legal Business Name): GRUNDY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E J AVE
GRUNDY CENTER IA
50638-2096
US

IV. Provider business mailing address

201 E J AVE
GRUNDY CENTER IA
50638-2096
US

V. Phone/Fax

Practice location:
  • Phone: 319-824-5421
  • Fax: 319-824-6291
Mailing address:
  • Phone: 319-824-5421
  • Fax: 319-824-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LISA A ZINKULA
Title or Position: CFO
Credential:
Phone: 319-824-5082