Healthcare Provider Details

I. General information

NPI: 1891744108
Provider Name (Legal Business Name): PALMER LUTHERAN HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 JEFFERSON STREET
WEST UNION IA
52175
US

IV. Provider business mailing address

112 JEFFERSON STREET
WEST UNION IA
52175
US

V. Phone/Fax

Practice location:
  • Phone: 563-422-3811
  • Fax: 563-422-9875
Mailing address:
  • Phone: 563-422-3811
  • Fax: 563-422-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number330070H
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number330070H
License Number StateIA

VIII. Authorized Official

Name: MS. PATRICE KUENNEN
Title or Position: CEO
Credential:
Phone: 563-422-3811