Provider Demographics
NPI:1811914575
Name:SIOUXLAND HEMATOLOGY ONCOLOGY ASSOCIATES LLP
Entity type:Organization
Organization Name:SIOUXLAND HEMATOLOGY ONCOLOGY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENOLA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-252-9303
Mailing Address - Street 1:230 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1733
Mailing Address - Country:US
Mailing Address - Phone:712-252-0088
Mailing Address - Fax:712-252-5271
Practice Address - Street 1:230 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1733
Practice Address - Country:US
Practice Address - Phone:712-252-0088
Practice Address - Fax:712-252-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21969207RH0003X
IA25530207RH0003X
IA29208207RH0003X
IA27148207RH0003X
NE19310207RH0003X
IA34068207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7767570Medicaid
IA0088955Medicaid
NE=========13Medicaid
NE=========-13Medicaid
IA0088955Medicaid