Greene County Medical Center
Organization Active NPI Clinic Pharmacy · Jefferson, IA
NPI 1346462785 · NPPES record last updated Jun 8, 2016
Key facts
- NPI
- 1346462785
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic Pharmacy 3336C0002X
- Legal business name
- GREENE COUNTY MEDICAL CENTER
- Practice address
- 1000 W Lincolnway St
Jefferson, IA 50129-1645 - Phone
- (515) 386-2114
- Fax
- (515) 386-3695
- NPI assigned
- May 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Mark A Vanderlinden
- Title
- Cfo
- Phone
- (515) 386-2114
Other NPIs on the same Medicare enrollment 10
Corporate family (same tax ID) 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040712000717 | IA | Part B Supplier - Clinic/Group Practice | 0143208595 |
Receives reassigned benefits from 30 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jefferson, IA |
National Provider Directory
- Tax ID family
- Greene Co Med
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic Pharmacy | 3336C0002X | Yes |
Addresses
Primary practice location
1000 W Lincolnway St
Jefferson, IA 50129-1645
Mailing address
1000 W Lincolnway St
Jefferson, IA 50129-1645
Phone (515) 386-2114
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0166454 | Medicaid | IA |
Other providers in Jefferson, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.