Provider Demographics
NPI:1891841441
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:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TYSLAND
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:563-422-9754
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:563-422-9754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUNDERSEN LUTHERAN HEALTH SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-26
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty