Basic Information
| Provider Information | |||||||||
| NPI: | 1255977740 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITYPOINT HEALTH - MARSHALLTOWN | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | UNITYPOINT CLINIC - FAMILY MEDICINE - GRUNDY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 UNITYPOINT WAY | ||||||||
| Address2: | |||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501584749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417545145 | ||||||||
| FaxNumber: | 6418446208 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 E J AVE STE 120 | ||||||||
| Address2: | |||||||||
| City: | GRUNDY CENTER | ||||||||
| State: | IA | ||||||||
| PostalCode: | 506382006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198246945 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2019 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FRIEDLY | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6417545145 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNITYPOINT HEALTH - MARSHALLTOWN | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.