Basic Information
| Provider Information | |||||||||
| NPI: | 1093714073 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SIOUXLAND SURGERY CENTER LIMITED LIABILITY PARTNERSHIP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DUNES SURGICAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 N SIOUX POINT RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052177000 | ||||||||
| FaxNumber: | 6052177015 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 N SIOUX POINT RD | ||||||||
| Address2: | |||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052323332 | ||||||||
| FaxNumber: | 6052320854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | MONICAL | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6052323332 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | N | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 284300000X | 10580 | SD | Y | Hospitals | Special Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0910554 | 05 | IA | MEDICAID | 5508000 | 05 | SD | MEDICAID | 430089 | 01 | TODAY'S OPTION | OTHER | 0108000 | 05 | SD | MEDICAID | 57049 | 01 | TRICARE WEST | OTHER | 26615 | 01 | ARAZ | OTHER | 28519 | 01 | SIOUX VALLEY HEALTH PLAN | OTHER | 80089 | 01 | DAKOTAS PLAN | OTHER | 430089 | 01 | HUMANA CLAIM CENTER | OTHER | 80089 | 01 | BAAI THE ADMINISTRATOR | OTHER | 80089 | 01 | SD | BLUE CROSS BLUE SHIELD | OTHER | H245262 | 01 | MIDLANDS CHOICE | OTHER |