Healthcare Provider Details

I. General information

NPI: 1720031610
Provider Name (Legal Business Name): SIOUXLAND PULMONARY CRITICAL CARE & SLEEP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWER ROAD SUITE 200
DAKOTA DUNES SD
57049-5098
US

IV. Provider business mailing address

101 TOWER ROAD SUITE 200
DAKOTA DUNES SD
57049-5098
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-4330
  • Fax: 605-217-2947
Mailing address:
  • Phone: 605-217-4330
  • Fax: 605-217-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4302
License Number StateSD

VIII. Authorized Official

Name: RHONDA J MCCOY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 605-217-2615