Basic Information
| Provider Information | |||||||||
| NPI: | 1487289955 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HAWARDEN REGIONAL HEALTHCARE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AKRON CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 11TH ST | ||||||||
| Address2: | |||||||||
| City: | HAWARDEN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510231903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7125513100 | ||||||||
| FaxNumber: | 7125513195 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 MILL ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510017712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7125682411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2020 | ||||||||
| LastUpdateDate: | 03/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | PULLMAN | ||||||||
| AuthorizedOfficialFirstName: | JAYSON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7125513100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HAWARDEN REGIONAL HEALTHCARE | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.