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General NPI Number Information
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NPI Number | 1275048977
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Entity Type | Organization
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Legal Business Name | GREATER REGIONAL MEDICAL CENTER
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 700 DAVIS AVE
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City | CORNING
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State | IA
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Zip | 50841-1419
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Country | US
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Telephone | 641-322-4431
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Fax | 641-322-5052
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Provider Business Mailing Address
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Address Line | 1700 W TOWNLINE ST
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City | CRESTON
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State | IA
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Zip | 50801-1054
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Country | US
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Telephone | 641-782-7091
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Fax | 641-782-3830
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Authorized Official
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Title or Position | CFO
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Name | MATTHEW L MCCUTCHAN
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Credential |
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Telephone | 641-782-3899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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