Organization
HAWARDEN REGIONAL HEALTHCARE CLINICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYSON P PULLMAN (PRESIDENT)
(712) 551-3103
Entity
Organization
Contact information
Practice address
1122 12TH ST, HAWARDEN, IA 51023-1900
(712) 551-3400
(712) 551-2691
Mailing address
1122 12TH ST, HAWARDEN, IA 51023-1900
(712) 551-3400
(712) 551-2691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0685032
—
IA
05
—
1013955004
—
IA
01
—
38497
WELLMARK BCBS IA GRP #
IA
Enumeration date
06/14/2006
Last updated
07/25/2024
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