Basic Information
| Provider Information | |||||||||
| NPI: | 1841261104 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HAWARDEN REGIONAL HEALTHCARE | ||||||||
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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: | 1111 11TH ST | ||||||||
| Address2: | |||||||||
| City: | HAWARDEN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 510231903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7125513100 | ||||||||
| FaxNumber: | 7125513195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | PULLMAN | ||||||||
| AuthorizedOfficialFirstName: | JAYSON | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7125513103 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 0165126 | 01 | IA | ELDERLY WAIVER | OTHER | 0685032 | 05 | IA | MEDICAID | 0601344 | 05 | IA | MEDICAID | 5520320 | 05 | SD | MEDICAID | 38497 | 01 | IA | WELLMARK BCBS | OTHER | 0120320 | 05 | SD | MEDICAID | 0135046 | 05 | IA | MEDICAID |