Provider Demographics
NPI:1841261104
Name:HAWARDEN REGIONAL HEALTHCARE
Entity type:Organization
Organization Name:HAWARDEN REGIONAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYSON
Authorized Official - Middle Name:P
Authorized Official - Last Name:PULLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-551-3103
Mailing Address - Street 1:1111 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWARDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51023-1903
Mailing Address - Country:US
Mailing Address - Phone:712-551-3100
Mailing Address - Fax:712-551-3195
Practice Address - Street 1:1111 11TH ST
Practice Address - Street 2:
Practice Address - City:HAWARDEN
Practice Address - State:IA
Practice Address - Zip Code:51023-1903
Practice Address - Country:US
Practice Address - Phone:712-551-3100
Practice Address - Fax:712-551-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0165126OtherELDERLY WAIVER
IA0685032Medicaid
IA0601344Medicaid
SD5520320Medicaid
IA38497OtherWELLMARK BCBS
SD0120320Medicaid
IA0135046Medicaid
IA0165126OtherELDERLY WAIVER
IA50940Medicare PIN
IA38497OtherWELLMARK BCBS
SD5520320Medicaid