Provider Demographics
NPI:1093714073
Name:SIOUXLAND SURGERY CENTER LIMITED LIABILITY PARTNERSHIP
Entity Type:Organization
Organization Name:SIOUXLAND SURGERY CENTER LIMITED LIABILITY PARTNERSHIP
Other - Org Name:DUNES SURGICAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MONICAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-232-3332
Mailing Address - Street 1:455 N SIOUX POINT RD
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5327
Mailing Address - Country:US
Mailing Address - Phone:605-217-7000
Mailing Address - Fax:605-217-7015
Practice Address - Street 1:600 N SIOUX POINT RD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5000
Practice Address - Country:US
Practice Address - Phone:605-232-3332
Practice Address - Fax:605-232-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X
SD10580284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes284300000XHospitalsSpecial Hospital
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0910554Medicaid
SD5508000Medicaid
430089OtherTODAY'S OPTION
SD0108000Medicaid
57049OtherTRICARE WEST
26615OtherARAZ
28519OtherSIOUX VALLEY HEALTH PLAN
80089OtherDAKOTAS PLAN
430089OtherHUMANA CLAIM CENTER
80089OtherBAAI THE ADMINISTRATOR
SD80089OtherBLUE CROSS BLUE SHIELD
H245262OtherMIDLANDS CHOICE
80089OtherBAAI THE ADMINISTRATOR
57049OtherTRICARE WEST
=========OtherCHAMPUS
80089OtherDAKOTAS PLAN