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General NPI Number Information
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NPI Number | 1841786951
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Entity Type | Organization
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Legal Business Name | GREAT RIVER PHYSICIANS AND CLINICS INC
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/02/2018
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Provider Practice Location Address
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Address Line | 801 S ROOSEVELT AVE STE C
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City | BURLINGTON
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State | IA
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Zip | 52601-1691
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Country | US
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Telephone | 319-768-1225
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 S GEAR AVE
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City | WEST BURLINGTON
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State | IA
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Zip | 52655-1679
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Country | US
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Telephone | 319-768-3471
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Fax | 319-768-3266
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | TRINA MARIE TUCKER
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Credential |
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Telephone | 319-768-3471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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