Provider Demographics
NPI:1265580898
Name:HAWKEYE CLINIC OF LUVERNE, PC
Entity type:Organization
Organization Name:HAWKEYE CLINIC OF LUVERNE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:LOOSBROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-283-2345
Mailing Address - Street 1:102 N FREEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-1628
Mailing Address - Country:US
Mailing Address - Phone:507-283-2345
Mailing Address - Fax:507-283-2346
Practice Address - Street 1:104 N FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1628
Practice Address - Country:US
Practice Address - Phone:507-283-2345
Practice Address - Fax:507-283-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN519524100Medicaid
MNU73168Medicare UPIN
MN1274670001Medicare NSC
MN519524100Medicaid