Provider Demographics
NPI:1891744108
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
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
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 1:112 JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:IA
Mailing Address - Zip Code:52175
Mailing Address - Country:US
Mailing Address - Phone:563-422-3811
Mailing Address - Fax:563-422-9875
Practice Address - Street 1:112 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175
Practice Address - Country:US
Practice Address - Phone:563-422-3811
Practice Address - Fax:563-422-9875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUNDERSEN LUTHERAN HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-06
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA330070H207Q00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0090423Medicaid
IA13603OtherBLUE CROSS ER GROUP
IA90423Medicaid
IA13603Medicare PIN