Healthcare Provider Details

I. General information

NPI: 1346462785
Provider Name (Legal Business Name): GREENE COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W LINCOLNWAY ST
JEFFERSON IA
50129-1645
US

IV. Provider business mailing address

1000 W LINCOLNWAY ST
JEFFERSON IA
50129-1645
US

V. Phone/Fax

Practice location:
  • Phone: 515-386-2114
  • Fax: 515-386-3695
Mailing address:
  • Phone: 515-386-2114
  • Fax: 515-386-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0166454
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MR. MARK A VANDERLINDEN
Title or Position: CFO
Credential:
Phone: 515-386-2114