Basic Information
| Provider Information | |||||||||
| NPI: | 1992767016 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIOUXLAND CYTOLOGY CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100559 | ||||||||
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| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295010559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436644300 | ||||||||
| FaxNumber: | 8436644308 | ||||||||
| Practice Location | |||||||||
| Address1: | 2730 PIERCE ST | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511043796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122556063 | ||||||||
| FaxNumber: | 7122556093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 02/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | QUESENBERRY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7122556063 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 29270 | IA | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 0557074 | 05 | IA | MEDICAID | 99659 | 01 | IA | BCBS | OTHER |