Provider Demographics
NPI:1013955004
Name:HAWARDEN REGIONAL HEALTHCARE CLINICS LLC
Entity Type:Organization
Organization Name:HAWARDEN REGIONAL HEALTHCARE CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:P
Authorized Official - Last Name:PULLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-551-3100
Mailing Address - Street 1:1122 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:HAWARDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51023-1928
Mailing Address - Country:US
Mailing Address - Phone:712-551-3400
Mailing Address - Fax:712-551-2691
Practice Address - Street 1:1122 AVENUE L
Practice Address - Street 2:
Practice Address - City:HAWARDEN
Practice Address - State:IA
Practice Address - Zip Code:51023-1928
Practice Address - Country:US
Practice Address - Phone:712-551-3400
Practice Address - Fax:712-551-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0685032Medicaid
IA168503Medicare Oscar/Certification
IAI14892Medicare PIN
IA0685032Medicaid