Provider Demographics
NPI:1912378480
Name:SIOUXLAND COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SIOUXLAND COMMUNITY HEALTH CENTER
Other - Org Name:SIOUXLAND COMMUNITY HEALTH CENTER OF NEBRASKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:712-202-1002
Mailing Address - Street 1:1021 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1436
Mailing Address - Country:US
Mailing Address - Phone:712-252-2477
Mailing Address - Fax:712-224-1895
Practice Address - Street 1:3410 FUTURES DR
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3917
Practice Address - Country:US
Practice Address - Phone:712-252-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0092080Medicaid
IA281840OtherMEDICARE OSCAR/CERTIFICATION