1093714073 NPI number — SIOUXLAND SURGERY CENTER LIMITED LIABILITY PARTNERSHIP

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093714073 NPI number — SIOUXLAND SURGERY CENTER LIMITED LIABILITY PARTNERSHIP

Employer Identification Number (EIN):

Provider Organization Name:

SIOUXLAND SURGERY CENTER LIMITED LIABILITY PARTNERSHIP

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

Provider Other Organization Name:

DUNES SURGICAL HOSPITAL

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:

1093714073

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

04/19/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

455 N SIOUX POINT RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DAKOTA DUNES

Provider Business Mailing Address State Name:

SD

Provider Business Mailing Address Postal Code:

57049-5327

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

605-217-7000

Provider Business Mailing Address Fax Number:

605-217-7015

Provider First Line Business Practice Location Address:

600 N SIOUX POINT RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

DAKOTA DUNES

Provider Business Practice Location Address State Name:

SD

Provider Business Practice Location Address Postal Code:

57049-5000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

605-232-3332

Provider Business Practice Location Address Fax Number:

605-232-0854

Provider Enumeration Date:

07/20/2005

Authorized Official Last Name:

MONICAL

Authorized Official First Name:

ROBERT

Authorized Official Middle Name:

Authorized Official Title or Position:

CEO

Authorized Official Telephone Number:

605-232-3332

• Taxonomy code: 163W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 284300000X , with the licence number: 10580 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0910554 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 5508000 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 430089 . This is a "TODAY'S OPTION" identifier . This identifiers is of the category "OTHER".
• Identifier: 0108000 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 57049 . This is a "TRICARE WEST" identifier . This identifiers is of the category "OTHER".
• Identifier: 26615 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
• Identifier: 28519 . This is a "SIOUX VALLEY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 80089 . This is a "DAKOTAS PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 430089 . This is a "HUMANA CLAIM CENTER" identifier . This identifiers is of the category "OTHER".
• Identifier: 80089 . This is a "BAAI THE ADMINISTRATOR" identifier . This identifiers is of the category "OTHER".
• Identifier: 80089 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: H245262 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".