Provider Demographics
NPI:1831469535
Name:GLENN E HURST, MD, P.C.
Entity Type:Organization
Organization Name:GLENN E HURST, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-290-8507
Mailing Address - Street 1:401 BROADWAY STREET
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51553-0306
Mailing Address - Country:US
Mailing Address - Phone:712-407-2086
Mailing Address - Fax:712-407-2087
Practice Address - Street 1:401 BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:IA
Practice Address - Zip Code:51553-0306
Practice Address - Country:US
Practice Address - Phone:712-407-2086
Practice Address - Fax:712-407-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA38242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty