Healthcare Provider Details

I. General information

NPI: 1912077348
Provider Name (Legal Business Name): HEGG MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HEGG DR
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 TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIA

VIII. Authorized Official

Name: MS. DELORES J VANGROOTHEEST
Title or Position: BUSINESS OFFICE - AR SUPERVISOR
Credential:
Phone: 712-476-8100