Healthcare Provider Details

I. General information

NPI: 1124133236
Provider Name (Legal Business Name): SIOUXLAND PATHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W ANCHOR DR SUITE 200
DAKOTA DUNES SD
57049-5335
US

IV. Provider business mailing address

350 W ANCHOR DR SUITE 200
DAKOTA DUNES SD
57049-5335
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-4270
  • Fax:
Mailing address:
  • Phone: 605-232-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number3912
License Number StateSD

VIII. Authorized Official

Name: MS. KRISTINE GIESE
Title or Position: DIRECTOR
Credential:
Phone: 605-232-4270