Provider Demographics
NPI:1124133236
Name:SIOUXLAND PATHOLOGY
Entity type:Organization
Organization Name:SIOUXLAND PATHOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-232-4270
Mailing Address - Street 1:350 W ANCHOR DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5335
Mailing Address - Country:US
Mailing Address - Phone:605-232-4270
Mailing Address - Fax:
Practice Address - Street 1:350 W ANCHOR DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5335
Practice Address - Country:US
Practice Address - Phone:605-232-4270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3912291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0005921OtherWELLMARK BLX SD
SD0005921OtherWELLMARK BLX SD
SD0005921OtherWELLMARK BLX SD
SD5921Medicare ID - Type Unspecified