Provider Demographics
NPI:1598849812
Name:HEGG MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HEGG MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEVENBERGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-476-8001
Mailing Address - Street 1:1202 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1420
Mailing Address - Country:US
Mailing Address - Phone:712-476-8000
Mailing Address - Fax:712-476-8090
Practice Address - Street 1:1202 21ST AVE
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1420
Practice Address - Country:US
Practice Address - Phone:712-476-8000
Practice Address - Fax:712-476-8090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEGGMEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA840049H275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA66145OtherWELLMARK
IA0655068Medicaid
IA16Z336Medicare ID - Type Unspecified
IA16Z336Medicare Oscar/Certification