Organization
AVERA HOME MEDICAL EQUIPMENT OF SPENCER HOSPITAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA D DIELEMAN (PRESIDENT/CEO)
(605) 322-1872
Entity
Organization
Contact information
Practice address
116 E 11TH ST, SUITE 104, SPENCER, IA 51301-4300
(712) 580-3923
Mailing address
116 E 11TH ST, SUITE 104, SPENCER, IA 51301-4300
(712) 580-3923
(712) 580-3921
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1-21-008187
IA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
1-21-008187
IA
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
1-21-008187
IA
Other
Enumeration date
08/05/2010
Last updated
10/31/2016
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