GREAT RIVER MEDICAL CENTER (NPI# 1053315002) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053315002 |
| Entity Type | Organization |
| Organization Name | GREAT RIVER MEDICAL CENTER |
| Other Organization Name | GREAT RIVER HOME HEALTH AND HOSPICE |
| Practice Address |
1306 S Washington Rd West Burlington IA 52655-1703 |
| Mailing Address |
Po Box 668 West Burlington IA 52655-0668 |
| Practice Telephone | 3197683626 |
| Practice Fax Number | 3197683633 |
| Mailing Telephone | 3197683628 |
| Mailing Fax Number | 3197683633 |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2018-10-01 |
| Authorized Official Name | MATTHEW WENZEL (CEO/PRESIDENT) |
| Authorized Official Telephone | 3197683260 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251G00000X | Hospice Care, Community Based | 290147H | IA | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | BCBS | 61567 | 01 |
| IA | COMMERCIAL | 161567 | 01 |
| Other Name | Type Code |
|---|---|
| Great River Home Health and Hospice | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265411144 | Great River Medical Center | Nursing Facility/Intermediate Care Facility | 1307 S Gear Ave, West Burlington, IA 52655-1604 | 2006-01-10 |
| 1811068646 | Great River Medical Center | General Acute Care Hospital | 1520 N Division St, Blytheville, AR 72315-1448 | 2006-11-13 |
| 1164433884 | Great River Medical Center | Emergency Medical Technician, Basic | 1221 S Gear Ave, West Burlington, IA 52655-1679 | 2006-08-10 |
| 1134168263 | Great River Medical Center | General Acute Care Hospital | 1221 S Gear Ave, West Burlington, IA 52655-1679 | 2006-06-05 |
| 1760461644 | Great River Medical Center | Home Health | 1306 S Washington Rd, West Burlington, IA 52655-1703 | 2006-01-10 |
| 1639158595 | Great River Medical Center | Rehabilitation Unit | 1221 S Gear Ave, West Burlington, IA 52655-1679 | 2006-01-10 |
| 1598744476 | Great River Medical Center | Home Delivered Meals | 1221 S Gear Ave, West Burlington, IA 52655-1679 | 2006-01-10 |
| 1386623262 | Great River Medical Center | Nursing Facility/Intermediate Care Facility | 1307 S Gear Ave, West Burlington, IA 52655-1604 | 2006-01-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | GREAT RIVER MEDICAL CENTER | 1221 S. Gear Ave, West Burlington, IA 52655 |
| Iowa Business Entities | GREAT RIVER MEDICAL CENTER STAFF FOUNDATION | 200 Jefferson Street, Burlington, IA 52601 |
| Street Address |
1306 S WASHINGTON RD |
| City | WEST BURLINGTON |
| State | IA |
| Zip Code | 52655-1703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760461644 | Great River Medical Center | Home Health | 1306 S Washington Rd, West Burlington, IA 52655-1703 | 2006-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679920045 | Breanne Vogel | Nurse Practitioner | 1225 South Gear Avenue, Suite 159, Great River Family Practice Clinic, West Burlington, IA 52655 | 2016-05-16 |
| 1639538010 | Kala Haisch | Nurse Practitioner | 1225 S. Gear Ave., Mercy Plaza, Suite 251, West Burlington, IA 52655 | 2016-02-15 |
| 1326305830 | Ryan Deets | Surgery | 1223 S Gear Ave Ste 202, West Burlington, IA 52655 | 2012-04-20 |
| 1912100173 | Jennifer Yancey | Dietitian, Registered | Great River Medical Center Center for Rehabilitation, 1401 W. Agency Rd., West Burlington, IA 52655 | 2007-06-06 |
| 1043348196 | Wilson Hearing Aids & Services Inc | Hearing Instrument Specialist | 313 E Agency Rd, West Burlington, IA 52655 | 2007-03-01 |
| 1730286204 | Eric A Hanks | Chiropractor | 433 E Mt Pleasant St, West Burlington, IA 52655 | 2006-09-19 |
| 1093825176 | Michael Steven Mathews | Dentist | 409 Layne Dr, West Burlington, IA 52655 | 2006-08-30 |
| 1952383259 | Craig Huston | Emergency Medical Technician, Basic | 1221d S Gear Ave, West Burlington, IA 52655 | 2005-11-14 |
| 1932101466 | Theron Jameson | Specialist | 1225 S Gear Ave, Ste 159, West Burlington, IA 52655 | 2005-08-15 |
| 1255339750 | Community Health Centers of Southeastern Iowa Inc | Internal Medicine | 1706 West Agency Road, West Burlington, IA 52655 | 2005-07-08 |
| Find all providers in zip 52655 | ||||
| Taxonomy Code | 251G00000X |
| Grouping | Agencies |
| Classification | Hospice Care, Community Based |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427665603 | Hillcrest Hospice LLC | Hospice Care, Community Based | 1702 W Broadway Ste 7, Council Bluffs, IA 51501-3867 | 2020-09-30 |
| 1144868928 | Physmed Iowa LLC | Hospice Care, Community Based | 1130 S Scott Blvd Ste 201, Iowa City, IA 52240-2908 | 2019-12-12 |
| 1750926481 | Moments Hospice of Des Moines LLC | Hospice Care, Community Based | 4150 Westown Pkwy Ste 106, West Des Moines, IA 50266-5901 | 2019-11-18 |
| 1285197160 | Visiting Nurse Services of Iowa | Hospice Care, Community Based | 118 N. Main Street, Mount Pleasant, IA 52641-2052 | 2019-04-09 |
| 1053877332 | Cedar Valley Hospice, LLC | Hospice Care, Community Based | 1850 Boyson Rd Ste A, Hiawatha, IA 52233-2316 | 2019-02-12 |
| 1598278434 | Mary Melissa Buchanan | Hospice Care, Community Based | 6101 Goodman Dr, Urbandale, IA 50322 | 2017-11-14 |
| 1083136410 | Compassion North America Home Health Services Corp | Hospice Care, Community Based | 1570 42nd Street Ne, Suite #2a, Cedar Rapids, IA 52402 | 2017-07-07 |
| 1588191829 | Unitypoint At Home | Hospice Care, Community Based | 290 Blairs Ferry Rd Ne Ste 100, Cedar Rapids, IA 52402-1618 | 2017-05-17 |
| 1043757495 | Avalon Hospice Iowa, LLC | Hospice Care, Community Based | 4601 Westown Pkwy, Suite 105, West Des Moines, IA 50266-1081 | 2017-01-24 |
| 1023401254 | Hospice of The Midwest, LLC | Hospice Care, Community Based | 9203 Northpark Dr, Johnston, IA 50131-2933 | 2015-03-12 |
| Find all providers with the same taxonomy | ||||
| City | WEST BURLINGTON |
| Zip Code | 52655 |
Please comment or provide details below to improve the information on GREAT RIVER MEDICAL CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.