Organization
GREAT RIVER ONCOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROHINI REGANTI MD (OWNER)
(319) 753-1220
Entity
Organization
Contact information
Practice address
1225 S GEAR AVE, SUITE 152, WEST BURLINGTON, IA 52655-1691
(319) 753-1220
(319) 753-5464
Mailing address
PO BOX 633, WEST BURLINGTON, IA 52655-0633
(319) 753-1220
(319) 753-5464
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0274860
—
IA
01
—
08894
BCBS GROUP PROVIDER NUMBE
IA
Enumeration date
07/17/2006
Last updated
08/22/2020
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