Provider Demographics
NPI:1881746105
Name:SIOUX CITY ALLERGY & ASTHMA ASSOCIATES, PC
Entity type:Organization
Organization Name:SIOUX CITY ALLERGY & ASTHMA ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-274-6884
Mailing Address - Street 1:4280 SERGEANT RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4634
Mailing Address - Country:US
Mailing Address - Phone:712-274-6884
Mailing Address - Fax:
Practice Address - Street 1:4280 SERGEANT RD
Practice Address - Street 2:SUITE 230
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4634
Practice Address - Country:US
Practice Address - Phone:712-274-6884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23362207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI3243Medicare UPIN
IAS72176Medicare UPIN
IAI3244Medicare UPIN