Provider Demographics
NPI:1265411284
Name:BETTY L HARMON
Entity type:Organization
Organization Name:BETTY L HARMON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HURLBURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-295-3996
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-0219
Mailing Address - Country:US
Mailing Address - Phone:515-295-3996
Mailing Address - Fax:515-295-5770
Practice Address - Street 1:114 E STATE ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-2734
Practice Address - Country:US
Practice Address - Phone:515-295-3996
Practice Address - Fax:515-295-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0487780001332B00000X
IA7613100001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0487780001Medicare NSC