Healthcare Provider Details

I. General information

NPI: 1992767016
Provider Name (Legal Business Name): SIOUXLAND CYTOLOGY CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PIERCE ST SUITE 405
SIOUX CITY IA
51104-3796
US

IV. Provider business mailing address

PO BOX 100559
FLORENCE SC
29501-0559
US

V. Phone/Fax

Practice location:
  • Phone: 712-255-6063
  • Fax: 712-255-6093
Mailing address:
  • Phone: 843-664-4300
  • Fax: 843-664-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number29270
License Number StateIA

VIII. Authorized Official

Name: DR. JAMES THOMAS QUESENBERRY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 712-255-6063