Healthcare Provider Details

I. General information

NPI: 1487289955
Provider Name (Legal Business Name): HAWARDEN REGIONAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MILL ST
AKRON IA
51001-7712
US

IV. Provider business mailing address

1111 11TH ST
HAWARDEN IA
51023-1903
US

V. Phone/Fax

Practice location:
  • Phone: 712-568-2411
  • Fax:
Mailing address:
  • Phone: 712-551-3100
  • Fax: 712-551-3195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAYSON PULLMAN
Title or Position: CEO
Credential:
Phone: 712-551-3100