Great River Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

03155 Issued in IA

Legal business name

GREAT RIVER MEDICAL GROUP

Practice address

4626 Progress Dr
Davenport, IA 52807-3483

Phone

(563) 441-9100

Fax

(563) 441-9101

NPI assigned

Jan 12, 2006

Organization subpart

No

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

Authorized official

Name

Lisa A Kopp, DO

Title

General PTR

Phone

(563) 441-9100

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750360251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 PROGRESS DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073483",
            "telephone_number": "563-441-9100",
            "fax_number": "563-441-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4626 PROGRESS DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073483",
            "telephone_number": "563-441-9100",
            "fax_number": "563-441-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVER MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOPP",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "GENERAL PTR",
        "authorized_official_telephone_number": "563-441-9100",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "03155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Polly Rae Graham, MBA, RD, LD
• Nicholas J Grande Jr., PAC
• Katie L Grant, MS, LCPC, LMHC, LPC
• Tina L Graw, MA
• Great Plains Orthotics & Prosthetics, Inc
• Green Country Dialysis LLC
• Lucheria C Green
• Mark S Green, RPH
• Lori Ann Greenwood, OT
• Gregg D Corrigan DPM PC

• Internal Medicine Physician in Davenport, IA
• Providers in Davenport, IA by specialty
• Internal Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.