Provider Demographics
NPI:1912988387
Name:HEGG MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HEGG MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARAE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUIT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:712-476-8051
Mailing Address - Street 1:1202 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1420
Mailing Address - Country:US
Mailing Address - Phone:712-476-8050
Mailing Address - Fax:712-476-8024
Practice Address - Street 1:1202 21ST AVE
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1420
Practice Address - Country:US
Practice Address - Phone:712-476-8050
Practice Address - Fax:712-476-8024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEGG MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-10
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA8400049H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0672360Medicaid
IA0672360Medicaid