Basic Information
| Provider Information | |||||||||
| NPI: | 1285809095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOPS II, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 PIERCE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511043755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122248678 | ||||||||
| FaxNumber: | 7122771662 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 PIERCE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511043755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122248678 | ||||||||
| FaxNumber: | 7122771662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 07/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | ELLERBROEK | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7122248678 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRI-STATE ORTHOPAEDIC PHYSICIANS, PLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 350225 | IA | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 1285809095 | 05 | IA | MEDICAID | DN3643 | 01 | IA | MEDICARE RR | OTHER |