Healthcare Provider Details

I. General information

NPI: 1952321416
Provider Name (Legal Business Name): SIOUXLAND UROLOGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5327
US

IV. Provider business mailing address

455 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5327
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-7000
  • Fax: 605-217-7015
Mailing address:
  • Phone: 605-217-7000
  • Fax: 605-217-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3861
License Number StateSD

VIII. Authorized Official

Name: MRS. VICKI R JAUER
Title or Position: OFFICE MANAGER
Credential:
Phone: 605-217-7000