Provider Demographics
NPI:1700878592
Name:SIOUXLAND WOMEN'S HEALTH CARE, P.C.
Entity Type:Organization
Organization Name:SIOUXLAND WOMEN'S HEALTH CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:JESSICA
Authorized Official - Last Name:HAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:712-252-0501
Mailing Address - Street 1:1000 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1431
Mailing Address - Country:US
Mailing Address - Phone:712-252-0501
Mailing Address - Fax:712-252-2024
Practice Address - Street 1:1000 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1431
Practice Address - Country:US
Practice Address - Phone:712-252-0501
Practice Address - Fax:712-252-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0170670Medicaid
IA0170670Medicaid
NE=========00Medicaid
SDS3751Medicare PIN
IA17067Medicare PIN