Basic Information
| Provider Information | |||||||||
| NPI: | 1417918921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCINERNEY | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 801 5TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122792010 | ||||||||
| FaxNumber: | 7122792770 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 5TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511011326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122792010 | ||||||||
| FaxNumber: | 7122792770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2006 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 32465 | IA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 21139 | 01 | SD | SIOUX VALLEY | OTHER | 7771053 | 05 | SD | MEDICAID | 0040593 | 01 | SD | WELLMARK BCBS | OTHER | 75305796315 | 05 | NE | MEDICAID | 75305796357049A002 | 01 | TRICARE | OTHER | 9211188 | 01 | SD | DAKOTA CARE | OTHER | 12784 | 01 | MIDLANDS CHOICE | OTHER | 47802 | 01 | IA | WELLMARK BCBS | OTHER | 1197269 | 05 | IA | MEDICAID |