Healthcare Provider Details

I. General information

NPI: 1629023429
Provider Name (Legal Business Name): HEGG MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 21ST AVENUE
ROCK VALLEY IA
51247-1445
US

IV. Provider business mailing address

2121 HEGG DR
ROCK VALLEY IA
51247-1445
US

V. Phone/Fax

Practice location:
  • Phone: 712-476-8100
  • Fax: 712-476-8190
Mailing address:
  • Phone: 712-476-8100
  • Fax: 712-476-8190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIA

VIII. Authorized Official

Name: MRS. VALERIE LADD LOUDENBACK
Title or Position: CLINIC MANAGER
Credential:
Phone: 712-476-8150