Basic Information
| Provider Information | |||||||||
| NPI: | 1629280839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEENA | ||||||||
| FirstName: | HEMLATA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 PIERCE ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511043725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122945000 | ||||||||
| FaxNumber: | 7122945091 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 PIERCE ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511043725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122945000 | ||||||||
| FaxNumber: | 7122945091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 10/23/2013 | ||||||||
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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 | 207Q00000X | 31693 | SC | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | 125051460 | IL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 41241 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 316937 | 05 | SC | MEDICAID |