1720031610 NPI number — SIOUXLAND PULMONARY CRITICAL CARE & SLEEP PC

Table of content: MR. MICHAEL JAMES ANDERSON IDMT (NPI 1982846416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720031610 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:
1720031610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 TOWER ROAD
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:
57049-5098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-217-4330
Provider Business Mailing Address Fax Number:
605-217-2947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 TOWER ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DAKOTA DUNES
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57049-5098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-217-4330
Provider Business Practice Location Address Fax Number:
605-217-2947
Provider Enumeration Date:
05/19/2006

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:  4302 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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