MEDICARE: SIOUX CITY ALLERGY & ASTHMA ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	23362	IA

General Provider Information

NPI Number	:	1881746105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIOUX CITY ALLERGY & ASTHMA ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	4280 SERGEANT RD
Second Line	:	SUITE 230
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4634
Country	:	US
Telephone Number	:	712-274-6884
Fax Number	:

Provider Business Practice Location Address
First Line	:	4280 SERGEANT RD
Second Line	:	SUITE 230
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4634
Country	:	US
Telephone Number	:	712-274-6884
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SANDY HAREN
Credential	:
Telephone Number	:	712-274-6884

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	08/22/2020

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