Provider Demographics
NPI:1073617080
Name:WOODBURY COUNTY GOVERNMENT
Entity Type:Organization
Organization Name:WOODBURY COUNTY GOVERNMENT
Other - Org Name:SIOUXLAND DISTRICT HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIEME
Authorized Official - Suffix:
Authorized Official - Credentials:MS BS
Authorized Official - Phone:712-279-6119
Mailing Address - Street 1:1014 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1435
Mailing Address - Country:US
Mailing Address - Phone:712-279-6119
Mailing Address - Fax:712-255-2601
Practice Address - Street 1:1014 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1435
Practice Address - Country:US
Practice Address - Phone:712-279-6119
Practice Address - Fax:712-255-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16D0648020291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0447417Medicaid