Healthcare Provider Details

I. General information

NPI: 1720278278
Provider Name (Legal Business Name): FAMILY HEALTH CARE OF SIOUXLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MAIN ST
MOVILLE IA
51039-7715
US

IV. Provider business mailing address

814 PIERCE ST SUITE 102
SIOUX CITY IA
51101-1058
US

V. Phone/Fax

Practice location:
  • Phone: 712-873-5225
  • Fax: 712-873-5206
Mailing address:
  • Phone: 712-226-2600
  • Fax: 712-226-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIA

VIII. Authorized Official

Name: SHANIN C MCCABE-HARDING
Title or Position: CEO
Credential:
Phone: 712-226-2600