Provider Demographics
NPI:1124056338
Name:AVERA HOLY FAMILY
Entity type:Organization
Organization Name:AVERA HOLY FAMILY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-362-6160
Mailing Address - Street 1:826 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-1528
Mailing Address - Country:US
Mailing Address - Phone:712-362-2631
Mailing Address - Fax:712-362-2636
Practice Address - Street 1:826 N 8TH ST
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-1528
Practice Address - Country:US
Practice Address - Phone:712-362-2631
Practice Address - Fax:712-362-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0077057Medicaid
IA32245OtherCARDIOLOGY SERV BL CR IA
MN677247100Medicaid
IA06272OtherCRNA BL CR IA
IA0272773Medicaid
IA27277OtherER SERV BL CR IA
608921HOOtherBC MN CRNA
MN74065HOOtherER CARD BL MN
IACD8536Medicare PIN
IA0077057Medicaid
MN677247100Medicaid