Provider Demographics
NPI:1790740884
Name:HAWARDEN REGIONAL HEALTHCARE
Entity Type:Organization
Organization Name:HAWARDEN REGIONAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:P
Authorized Official - Last Name:PULLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-551-3103
Mailing Address - Street 1:1111 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWARDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51023-1903
Mailing Address - Country:US
Mailing Address - Phone:712-551-3112
Mailing Address - Fax:712-551-3195
Practice Address - Street 1:1111 11TH ST
Practice Address - Street 2:
Practice Address - City:HAWARDEN
Practice Address - State:IA
Practice Address - Zip Code:51023-1903
Practice Address - Country:US
Practice Address - Phone:712-551-3112
Practice Address - Fax:712-551-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X
IA840126H282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA16Z311Medicare Oscar/Certification