Provider Demographics
NPI:1114981792
Name:MARIAN HEALTH CENTER-SMHC
Entity Type:Organization
Organization Name:MARIAN HEALTH CENTER-SMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-2297
Mailing Address - Street 1:801 5TH ST
Mailing Address - Street 2:STE 2211
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1394
Mailing Address - Country:US
Mailing Address - Phone:712-279-5880
Mailing Address - Fax:712-279-5888
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:STE 2211
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1394
Practice Address - Country:US
Practice Address - Phone:712-279-5880
Practice Address - Fax:712-279-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6043336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0140780Medicaid
SD8533770Medicaid
SD8533770Medicaid
NE=========50Medicaid