1194901314 NPI number — SIOUXLAND PULMONARY CRITICAL CARE & SLEEP PC

Table of content: (NPI 1194901314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194901314 NPI number — SIOUXLAND PULMONARY CRITICAL CARE & SLEEP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIOUXLAND PULMONARY CRITICAL CARE & SLEEP PC
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:
Provider Other Organization Name Type Code:
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:
1194901314
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 TOWER RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DAKOTA DUNES
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57049-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-217-2615
Provider Business Mailing Address Fax Number:
605-217-2915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 5TH 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:
51101-1326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-217-2615
Provider Business Practice Location Address Fax Number:
605-217-2915
Provider Enumeration Date:
01/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
605-217-2615

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  28247 , 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)





Copyright © 2007-2024 www.npivalidator.com