Basic Information
| Provider Information | |||||||||
| NPI: | 1629226832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREENE COUNTY MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | ADVANCED WOMEN'S CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2213 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503125305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152373974 | ||||||||
| FaxNumber: | 5158832692 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W LINCOLNWAY ST | ||||||||
| Address2: | SUITE AWC | ||||||||
| City: | JEFFERSON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501291645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153862240 | ||||||||
| FaxNumber: | 5153862280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | VANDERLINDEN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5153862114 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.