Basic Information
| Provider Information | |||||||||
| NPI: | 1124133236 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIOUXLAND PATHOLOGY | ||||||||
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| OtherOrganizationName: | DUNES MEDICAL LAB SIOUXLAND PATHOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 W ANCHOR DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052324270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 W ANCHOR DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052324270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GIESE | ||||||||
| AuthorizedOfficialFirstName: | KRISTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6052324270 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 3912 | SD | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 0005921 | 01 | SD | WELLMARK BLX SD | OTHER |