Healthcare Provider Details

I. General information

NPI: 1962221903
Provider Name (Legal Business Name): SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W 2ND ST
SUTHERLAND IA
51058-7615
US

IV. Provider business mailing address

300 SIOUX VALLEY DR
CHEROKEE IA
51012-1205
US

V. Phone/Fax

Practice location:
  • Phone: 712-446-2567
  • Fax: 712-446-2631
Mailing address:
  • Phone: 712-225-3368
  • Fax: 712-225-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARY JORDAN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 712-225-5101