Provider Demographics
NPI:1205916426
Name:SIOUXLAND REGIONAL TRANSIT SYSTEM
Entity type:Organization
Organization Name:SIOUXLAND REGIONAL TRANSIT SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-6919
Mailing Address - Street 1:1122 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1077
Mailing Address - Country:US
Mailing Address - Phone:712-279-6919
Mailing Address - Fax:712-279-6920
Practice Address - Street 1:1122 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1452
Practice Address - Country:US
Practice Address - Phone:712-279-6919
Practice Address - Fax:712-279-6920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0116947347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0116947Medicaid