Basic Information
| Provider Information | |||||||||
| NPI: | 1194901314 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIOUXLAND PULMONARY CRITICAL CARE & SLEEP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 TOWER RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DAKOTA DUNES | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570495007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052172615 | ||||||||
| FaxNumber: | 6052172915 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 5TH ST | ||||||||
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| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052172615 | ||||||||
| FaxNumber: | 6052172915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2008 | ||||||||
| LastUpdateDate: | 01/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCCOY | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 6052172615 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 28247 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.