Healthcare Provider Details

I. General information

NPI: 1801060306
Provider Name (Legal Business Name): HAWARDEN REGIONAL HEALTHCARE CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 MAIN ST
IRETON IA
51027-7794
US

IV. Provider business mailing address

1122 12TH ST
HAWARDEN IA
51023-1900
US

V. Phone/Fax

Practice location:
  • Phone: 712-278-1011
  • Fax: 712-551-2691
Mailing address:
  • Phone: 712-551-3400
  • Fax: 712-551-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAYSON P PULLMAN
Title or Position: PRESIDENT
Credential:
Phone: 712-551-3103