1003956343 NPI number — PEDIATRIC HEMATOLOGY CLINIC LTD

Table of content: (NPI 1003956343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003956343 NPI number — PEDIATRIC HEMATOLOGY CLINIC LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC HEMATOLOGY CLINIC LTD
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:
1003956343
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:
1000 E 21ST ST
Provider Second Line Business Mailing Address:
SUITE 3100
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57105-1035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-322-7595
Provider Business Mailing Address Fax Number:
605-322-7599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E 21ST ST
Provider Second Line Business Practice Location Address:
SUITE 3100
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-1035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-322-7595
Provider Business Practice Location Address Fax Number:
605-322-7599
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HANNA
Authorized Official First Name:
MARWAN
Authorized Official Middle Name:
DAOUD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
605-322-7595

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  1562 , 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)

  • Identifier: 3008526 . This is a "MEDICA GROUP NUMBER" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4997079 . This is a "BCBS OF SD GROUP NUMBER" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com