Basic Information
| Provider Information | |||||||||
| NPI: | 1275203846 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARY GREELEY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 DUFF AVE | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500105745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152392011 | ||||||||
| FaxNumber: | 5152392060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 DUFF AVE STE 1431 | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500105745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152392011 | ||||||||
| FaxNumber: | 5152392060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2021 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | DIETER | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 5152392103 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.