GRAND ITASCA CLINIC AND HOSPITAL (NPI# 1669426631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669426631 |
| Entity Type | Organization |
| Organization Name | GRAND ITASCA CLINIC AND HOSPITAL |
| Practice Address |
1601 Golf Course Rd Grand Rapids MN 55744-8648 |
| Practice Telephone | 2183263401 |
| Practice Fax Number | 2189991461 |
| Mailing Telephone | 2183263401 |
| Mailing Fax Number | 2189991461 |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2016-03-14 |
| Authorized Official Name | MICHAEL J. YOUSO (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2183265000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 273Y00000X | Rehabilitation Unit | MN | Hospital Units | |
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 282N00000X | General Acute Care Hospital | 330789 | MN | Hospitals |
| N | 275N00000X | Medicare Defined Swing Bed Unit | Hospital Units | ||
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 038345700 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902379159 | Grand Itasca Clinic and Hospital | Pharmacy | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-01-09 |
| 1225441157 | Grand Itasca Clinic and Hospital | Pharmacy | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2014-06-09 |
| 1023326980 | Grand Itasca Clinic and Hospital | Non-Pharmacy Dispensing Site | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2010-09-14 |
| 1558435131 | Grand Itasca Clinic and Hospital | Home Health | 111 Se 3rd St, Grand Rapids, MN 55744-3663 | 2006-11-17 |
| Street Address |
1601 GOLF COURSE RD |
| City | GRAND RAPIDS |
| State | MN |
| Zip Code | 55744-8648 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326023060 | Jack Victor Carlisle | Family Medicine | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2005-12-14 |
| 1568076602 | Tyler Wesley Waller | Pharmacist | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2020-09-05 |
| 1699397042 | Tiffany Alicia Axtman | Nurse Practitioner | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2020-05-08 |
| 1710511282 | Kelly Manner | Dietitian, Registered | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2020-02-24 |
| 1285273292 | Patrick James Nelson | Physician Assistant | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-12-23 |
| 1801446943 | Natalie Jo Castle | Physician Assistant | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-09-19 |
| 1578121356 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-06-05 |
| 1487210233 | Jake Heggem | Pharmacist | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-05-17 |
| 1902379159 | Grand Itasca Clinic and Hospital | Pharmacy | 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | 2019-01-09 |
| 1548768534 | Michelle Overbye | Nurse Practitioner | 1601 Golf Course Rd, Grand Rapids, MN 55744 | 2018-01-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710587696 | Friesen & Friesen, Inc | Assisted Living Facility | 1971 Ne 1st Avenue, Grand Rapids, MN 55744 | 2020-10-29 |
| 1699392555 | Duane Stanley Helmer | Counselor | First Call for Help of Itasca County, 1707 Nw 4th Street Suite B, Grand Rapids, MN 55744 | 2020-06-26 |
| 1821631391 | Patrice Marie Curtiss | Technician | 23792 Winckler Road, Grand Rapids, MN 55744 | 2019-10-28 |
| 1578117438 | Christina Marie Hubred | Advanced Practice Dental Therapist | Miskovich Dental Clinic, 1121 Se 4th Avenue, Grand Rapids, MN 55744 | 2019-07-30 |
| 1780081877 | Fcsl Grand Rapids, LLC | Assisted Living Facility | 949 1/2 Sw 11th Street, Grand Rapids, MN 55744 | 2014-12-04 |
| 1912311333 | Doctor V LLC | Psychologist | 2002 Cromell Drive, Hope House of Itasca County, Laprairie, MN 55744 | 2014-06-13 |
| 1104244987 | Linda Reinen-thompson | Contractor | 34307 Hwy. 38, Grand Rapids, MN 55744 | 2014-03-31 |
| 1275883266 | Lana Rae Jacobson | Registered Nurse | 1401 Nw 9th Street, Grand Rapids, MN 55744 | 2012-09-17 |
| 1518252048 | David Allen Griggs | Pharmacist | 2140 S.pokegama Ave., T-0904, Target, Grand Rapids, MN 55744 | 2011-06-13 |
| 1447575063 | Kelly Ann Shermoen | Pharmacist | 18 Se 10th Street, Grand Rapids, MN 55744 | 2010-04-07 |
| Find all providers in zip 55744 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154967651 | Obsidian Chiropractic, LLC | Clinic/Center | 2504 Ardmore St Se Ste 102, Grand Rapids, MI 49506-4901 | 2019-11-20 |
| 1356816805 | Building Blocks Therapy Services, LLC | Clinic/Center | 600 3 Mile Rd Nw Ste 102, Grand Rapids, MI 49544-1685 | 2018-10-11 |
| 1427227156 | Joshuatree Internal Medicine | Clinic/Center | 825 Parchment Dr Se Ste 200, Grand Rapids, MI 49546-2382 | 2008-02-27 |
| 1518152735 | Aquinas College Inc | Clinic/Center | 1607 Robinson Rd Se, Wege Center, Grand Rapids, MI 49506-1741 | 2007-09-11 |
| 1013109438 | American Current Care of Michigan PC | Clinic/Center | 933 Three Mile Road, Suite 110, Grand Rapids, MI 49544 | 2007-08-10 |
| 1710927751 | North Central Cardiovascular Diagnostics, LLC | Clinic/Center | 111 Se 3rd St, Grand Rapids, MN 55744-3663 | 2006-06-07 |
| 1962494120 | Spectrum Health Hospitals | Clinic/Center | 35 Michigan St Ne, Grand Rapids, MI 49503-2514 | 2005-08-15 |
| 1487153938 | Karek Psychological Services, LLC | Clinic/Center | 4467 Cascade Rd Se Ste 4469, Grand Rapids, MI 49546-3776 | 2018-02-09 |
| 1386043719 | Grand Valley State University | Clinic/Center | 72 Sheldon Blvd Se, Grand Rapids, MI 49503-4234 | 2014-08-21 |
| 1295015360 | Hope Network Rehabiliation Services | Clinic/Center | 1490 E Beltline Ave Se, Grand Rapids, MI 49506-4336 | 2011-08-22 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 55744 |
Please comment or provide details below to improve the information on GRAND ITASCA CLINIC AND HOSPITAL.
| 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.