Provider Demographics
NPI:1992767016
Name:SIOUXLAND CYTOLOGY CONSULTANTS LLC
Entity type:Organization
Organization Name:SIOUXLAND CYTOLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:QUESENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-255-6063
Mailing Address - Street 1:PO BOX 100559
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0559
Mailing Address - Country:US
Mailing Address - Phone:843-664-4300
Mailing Address - Fax:843-664-4308
Practice Address - Street 1:2730 PIERCE ST
Practice Address - Street 2:SUITE 405
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3796
Practice Address - Country:US
Practice Address - Phone:712-255-6063
Practice Address - Fax:712-255-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29270207ZP0102X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0557074Medicaid
IA99659OtherBCBS
IAP00058454Medicare PIN
IAI9871Medicare PIN