Provider Demographics
NPI:1417918921
Name:MCINERNEY, ELIZABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MCINERNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1326
Mailing Address - Country:US
Mailing Address - Phone:712-279-2010
Mailing Address - Fax:712-279-2770
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2010
Practice Address - Fax:712-279-2770
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD21139OtherSIOUX VALLEY
SD7771053Medicaid
SD0040593OtherWELLMARK BCBS
NE75305796315Medicaid
75305796357049A002OtherTRICARE
SD9211188OtherDAKOTA CARE
12784OtherMIDLANDS CHOICE
IA47802OtherWELLMARK BCBS
IA1197269Medicaid
SD0040593OtherWELLMARK BCBS
IAH11632Medicare UPIN
75305796357049A002OtherTRICARE
080187819Medicare ID - Type UnspecifiedRAILROAD
SD40593Medicare ID - Type Unspecified