1033165873 NPI number — SIOUXLAND MEDICAL EDUCATION FOUNDATION PHARMACY

Table of content: (NPI 1033165873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033165873 NPI number — SIOUXLAND MEDICAL EDUCATION FOUNDATION PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIOUXLAND MEDICAL EDUCATION FOUNDATION PHARMACY
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:
SIOUXLAND MEDICAL EDUCATION FOUNDATION
Provider Other Organization Name Type Code:
5
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:
1033165873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 PIERCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51104-3725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-294-5000
Provider Business Mailing Address Fax Number:
712-294-5091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 PIERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51104-3725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-294-5000
Provider Business Practice Location Address Fax Number:
712-294-5091
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WERNER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
712-294-5000

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  17710 , 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: 0146191 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com