Provider Demographics
NPI:1891791901
Name:SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:CHEROKEE REGIONAL CLINIC - MARCUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-225-1505
Mailing Address - Street 1:300 SIOUX VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1205
Mailing Address - Country:US
Mailing Address - Phone:712-225-6265
Mailing Address - Fax:712-225-6800
Practice Address - Street 1:300 E PINE ST
Practice Address - Street 2:
Practice Address - City:MARCUS
Practice Address - State:IA
Practice Address - Zip Code:51035-7196
Practice Address - Country:US
Practice Address - Phone:712-376-4600
Practice Address - Fax:712-376-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0105742Medicaid
IA0105742Medicaid