Healthcare Provider Details

I. General information

NPI: 1114012085
Provider Name (Legal Business Name): GRUNDY COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/07/2013
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 Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

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