Provider Demographics
NPI:1720031610
Name:SIOUXLAND PULMONARY CRITICAL CARE & SLEEP PC
Entity Type:Organization
Organization Name:SIOUXLAND PULMONARY CRITICAL CARE & SLEEP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-217-2615
Mailing Address - Street 1:101 TOWER ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5098
Mailing Address - Country:US
Mailing Address - Phone:605-217-4330
Mailing Address - Fax:605-217-2947
Practice Address - Street 1:101 TOWER ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5098
Practice Address - Country:US
Practice Address - Phone:605-217-4330
Practice Address - Fax:605-217-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4302207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E97414Medicare UPIN