Basic Information
| Provider Information | |||||||||
| NPI: | 1801060306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAWARDEN REGIONAL HEALTHCARE CLINICS, LLC | ||||||||
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| OtherOrganizationName: | HAWARDEN COMMUNITY CLINIC, LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1122 AVENUE L | ||||||||
| Address2: | |||||||||
| City: | HAWARDEN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7125513400 | ||||||||
| FaxNumber: | 7125512691 | ||||||||
| Practice Location | |||||||||
| Address1: | 318 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | IRETON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122781011 | ||||||||
| FaxNumber: | 7125512691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 10/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | PULLMAN | ||||||||
| AuthorizedOfficialFirstName: | JAYSON | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7125513103 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.