1891791901 NPI number — SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION

Table of content: (NPI 1891791901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891791901 NPI number — SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
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:
CHEROKEE REGIONAL CLINIC - MARCUS
Provider Other Organization Name Type Code:
3
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:
1891791901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 SIOUX VALLEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEROKEE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51012-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-225-6265
Provider Business Mailing Address Fax Number:
712-225-6800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 E PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARCUS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51035-7196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-376-4600
Provider Business Practice Location Address Fax Number:
712-376-4709
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BIERMAN
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
712-225-1505

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0105742 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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