Provider Demographics
NPI:1205030731
Name:PIERCE STREET SAME DAY SURGERY, LC
Entity Type:Organization
Organization Name:PIERCE STREET SAME DAY SURGERY, LC
Other - Org Name:PIERCE STREET SAME DAY SURGERY, LC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-294-8911
Mailing Address - Street 1:6128 S LYNCREST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2560
Mailing Address - Country:US
Mailing Address - Phone:844-716-1509
Mailing Address - Fax:605-274-6186
Practice Address - Street 1:2730 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3796
Practice Address - Country:US
Practice Address - Phone:712-294-7773
Practice Address - Fax:712-279-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025588200Medicaid
IA1205030731Medicaid
NE10025588200Medicaid