1508810177 NPI number — AVERA HOLY FAMILY

Table of content: (NPI 1508810177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508810177 NPI number — AVERA HOLY FAMILY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVERA HOLY FAMILY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AVERA HOLY FAMILY HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508810177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
826 N 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESTHERVILLE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51334-1528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-362-2631
Provider Business Mailing Address Fax Number:
712-362-2636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
826 N 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESTHERVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51334-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-362-2631
Provider Business Practice Location Address Fax Number:
712-362-2636
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERZBERG
Authorized Official First Name:
DEB
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
712-362-6160

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  320014H , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0600023 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0016HHO . This is a "BLUE CROSS CAH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 60002 . This is a "WELLMARK CAH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 677247100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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