=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427015585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRUNDY COUNTY MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2006
-----------------------------------------------------
Last Update Date | 03/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E J AVE
-----------------------------------------------------
City | GRUNDY CENTER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50638-2096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-824-5421
-----------------------------------------------------
Fax | 319-824-6291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 E J AVE
-----------------------------------------------------
City | GRUNDY CENTER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50638-2096
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-824-5421
-----------------------------------------------------
Fax | 319-824-6291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MS. LISA A. ZINKULA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 319-824-5082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 380114H
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 380114H
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------