Provider Demographics
NPI:1558722579
Name:PALMER LUTHERAN HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:PALMER LUTHERAN HEALTH CENTER, INC.
Other - Org Name:GUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINICS - FAYETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-422-3811
Mailing Address - Street 1:110 KING ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:IA
Mailing Address - Zip Code:52142-9735
Mailing Address - Country:US
Mailing Address - Phone:563-425-3381
Mailing Address - Fax:
Practice Address - Street 1:110 KING ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:IA
Practice Address - Zip Code:52142-9735
Practice Address - Country:US
Practice Address - Phone:563-425-3381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-18
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care