Provider Demographics
NPI:1083652887
Name:AVERA HOLY FAMILY
Entity Type:Organization
Organization Name:AVERA HOLY FAMILY
Other - Org Name:AVERA MEDICAL GROUP ESTHERVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-362-6160
Mailing Address - Street 1:926 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-1300
Mailing Address - Country:US
Mailing Address - Phone:712-362-6501
Mailing Address - Fax:712-362-7190
Practice Address - Street 1:926 N 8TH ST
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-1300
Practice Address - Country:US
Practice Address - Phone:712-362-6501
Practice Address - Fax:712-362-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076000Medicaid
IA07600Medicare ID - Type Unspecified
IA0076000Medicaid