Healthcare Provider Details

I. General information

NPI: 1285809095
Provider Name (Legal Business Name): TOPS II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 PIERCE ST SUITE 101
SIOUX CITY IA
51104-3755
US

IV. Provider business mailing address

2800 PIERCE ST SUITE 101
SIOUX CITY IA
51104-3755
US

V. Phone/Fax

Practice location:
  • Phone: 712-224-8678
  • Fax: 712-277-1662
Mailing address:
  • Phone: 712-224-8678
  • Fax: 712-277-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number350225
License Number StateIA

VIII. Authorized Official

Name: KATHY ELLERBROEK
Title or Position: BILLING MANAGER
Credential:
Phone: 712-224-8678