Healthcare Provider Details

I. General information

NPI: 1639158595
Provider Name (Legal Business Name): SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 S GEAR AVE
WEST BURLINGTON IA
52655-1679
US

IV. Provider business mailing address

1221 S GEAR AVE
WEST BURLINGTON IA
52655-1679
US

V. Phone/Fax

Practice location:
  • Phone: 319-768-3626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number290147H
License Number StateIA

VIII. Authorized Official

Name: MICHAEL MCCOY
Title or Position: CEO
Credential:
Phone: 319-768-3268