Provider Demographics
NPI:1558355305
Name:SIOUXLAND COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SIOUXLAND COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-252-2477
Mailing Address - Street 1:1021 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1436
Mailing Address - Country:US
Mailing Address - Phone:712-252-2477
Mailing Address - Fax:712-252-5920
Practice Address - Street 1:1021 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1436
Practice Address - Country:US
Practice Address - Phone:712-252-2477
Practice Address - Fax:712-252-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0092080Medicaid
IA161802Medicare Oscar/Certification