Provider Demographics
NPI:1629023429
Name:HEGG MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HEGG MEMORIAL HOSPITAL
Other - Org Name:HEGG MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:LADD
Authorized Official - Last Name:LOUDENBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-476-8150
Mailing Address - Street 1:2121 HEGG DR
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1445
Mailing Address - Country:US
Mailing Address - Phone:712-476-8100
Mailing Address - Fax:712-476-8190
Practice Address - Street 1:1202 21ST AVENUE
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1445
Practice Address - Country:US
Practice Address - Phone:712-476-8100
Practice Address - Fax:712-476-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207Q00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0201089Medicaid
IA0129528Medicaid
IA51866Medicare PIN
IAI8818Medicare PIN
IA0129528Medicaid