Provider Demographics
NPI:1558494138
Name:SIOUX CENTER HEALTH
Entity type:Organization
Organization Name:SIOUX CENTER HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-722-8153
Mailing Address - Street 1:1101 9 ST SE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-2501
Mailing Address - Country:US
Mailing Address - Phone:712-722-2609
Mailing Address - Fax:712-722-4325
Practice Address - Street 1:1101 9 ST SE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-2501
Practice Address - Country:US
Practice Address - Phone:712-722-2609
Practice Address - Fax:712-722-4325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIOUX CENTER HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0429316Medicaid
IAI11561Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER