=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013955004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAWARDEN REGIONAL HEALTHCARE CLINICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 09/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1122 12TH ST
-----------------------------------------------------
City | HAWARDEN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51023-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-551-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1122 12TH ST
-----------------------------------------------------
City | HAWARDEN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51023-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-551-3400
-----------------------------------------------------
Fax | 712-551-2691
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAYSON P PULLMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-551-3100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------