Provider Demographics
NPI:1053315002
Name:SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:SOUTHEAST IOWA REGIONAL MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-768-6268
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-0668
Mailing Address - Country:US
Mailing Address - Phone:319-768-3628
Mailing Address - Fax:319-768-3633
Practice Address - Street 1:1306 S WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1703
Practice Address - Country:US
Practice Address - Phone:319-768-3626
Practice Address - Fax:319-768-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA290147H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA61567OtherBCBS
IA161567OtherCOMMERCIAL
IA61567OtherBCBS