Provider Demographics
NPI:1912921198
Name:MARIAN HEALTH CENTER - SMHC
Entity Type:Organization
Organization Name:MARIAN HEALTH CENTER - SMHC
Other - Org Name:MERCYONE SIOUXLAND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M. ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANNERY-HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-279-2018
Mailing Address - Street 1:801 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1326
Mailing Address - Country:US
Mailing Address - Phone:712-279-2010
Mailing Address - Fax:712-279-5631
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2010
Practice Address - Fax:712-279-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA970112H273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6T153OtherWELLMARK BLUE CROSS
SD0235062Medicaid
IA0601534Medicaid
SD0235062Medicaid
IA16T153Medicare Oscar/Certification