Provider Demographics
NPI:1447293063
Name:VIRGINIA GAY HOSPITAL, INC
Entity type:Organization
Organization Name:VIRGINIA GAY HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-472-6200
Mailing Address - Street 1:504 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-2254
Mailing Address - Country:US
Mailing Address - Phone:319-472-6300
Mailing Address - Fax:
Practice Address - Street 1:504 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-2254
Practice Address - Country:US
Practice Address - Phone:319-472-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA GAY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0144915Medicaid
IA55965Medicare PIN
IA163461Medicare Oscar/Certification