NPIMap

Organization Active NPI

Grinnell Regional Medical Center

Doing business as Victor Health Center

  • Rural Health Clinic/Center
  • Victor, IA
National Provider Identifier
1720154263
Registry record updated Jan 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRINNELL REGIONAL MEDICAL CENTER
Doing business as
Victor Health Center
Practice address
709 2ND St
Victor, IA 52347-7709
Phone
(319) 647-7511
Fax
(319) 647-7521
NPI assigned
Nov 27, 2006
Last updated
Jan 13, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
GRINNELL REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kyle M Wilcox
Title
Cfo
Phone
(641) 236-2919

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Physician Assistant 363A00000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

709 2ND St
Victor, IA 52347-7709

Mailing address

709 2ND St
Victor, IA 52347-7709
Phone (319) 647-7511

Other identifiers 1

IdentifierTypeStateIssuer
0685107MedicaidIA

Other names 1

  • VICTOR HEALTH CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Part of
Lynnville Medical Clini

Locations

202 4th Ave
Ste 200
Grinnell, IA 50112

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Sep 1, 2021 Change of OwnershipThis provider was the seller Victor Family Medical ClinicCCN 168510, IA, NPI 1679246722

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515801600000",
    "number": "1720154263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 2ND ST",
            "city": "VICTOR",
            "state": "IA",
            "postal_code": "523477709",
            "telephone_number": "319-647-7511",
            "fax_number": "319-647-7521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 2ND ST",
            "city": "VICTOR",
            "state": "IA",
            "postal_code": "523477709",
            "telephone_number": "319-647-7511",
            "fax_number": "319-647-7521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRINNELL REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRINNELL REGIONAL MEDICAL CENTER",
        "enumeration_date": "2006-11-27",
        "last_updated": "2018-01-13",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "641-236-2919",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0685107",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VICTOR HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victor, IA

Sources for this page

Verify at the official NPI Registry.