Provider Demographics
NPI:1710302575
Name:SIOUXLAND DIAGNOSTIC LAB SERVICES LLC
Entity Type:Organization
Organization Name:SIOUXLAND DIAGNOSTIC LAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FINKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-391-2005
Mailing Address - Street 1:825 N 90TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2702
Mailing Address - Country:US
Mailing Address - Phone:402-391-2005
Mailing Address - Fax:402-391-1302
Practice Address - Street 1:825 N 90TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2702
Practice Address - Country:US
Practice Address - Phone:402-391-2005
Practice Address - Fax:402-391-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory