Provider Demographics
NPI:1477768828
Name:AVERA HOLY FAMILY
Entity Type:Organization
Organization Name:AVERA HOLY FAMILY
Other - Org Name:AVERA HOLY FAMILY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:826 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-1528
Mailing Address - Country:US
Mailing Address - Phone:712-362-2631
Mailing Address - Fax:712-362-2636
Practice Address - Street 1:826 N 8TH ST
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-1528
Practice Address - Country:US
Practice Address - Phone:712-362-2631
Practice Address - Fax:712-362-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA320014H207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0482208Medicaid
IA3060376Medicaid
IA0482190Medicaid
IA1078113Medicaid
IA1082776Medicaid
IA2155473Medicaid
IA3060418Medicaid