Provider Demographics
NPI:1710950654
Name:PALMER LUTHERAN HEALTH CENTER, INC
Entity Type:Organization
Organization Name:PALMER LUTHERAN HEALTH CENTER, INC
Other - Org Name:GUNDERSEN PALMER HOME MEDICAL SUPPLY
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:DM
Authorized Official - Phone:563-422-3811
Mailing Address - Street 1:200 JEFFERSON ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WEST UNION
Mailing Address - State:IA
Mailing Address - Zip Code:52175-1024
Mailing Address - Country:US
Mailing Address - Phone:563-422-9714
Mailing Address - Fax:563-422-9875
Practice Address - Street 1:200 JEFFERSON ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-1024
Practice Address - Country:US
Practice Address - Phone:563-422-9714
Practice Address - Fax:563-422-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
IA6396332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0112599Medicaid
IA43326OtherWELLMARK OF IOWA
IA0112599Medicaid
IA0112599Medicaid