Healthcare Provider Details

I. General information

NPI: 1669496337
Provider Name (Legal Business Name): SIOUXLAND ANESTHESIOLOGY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5000
US

IV. Provider business mailing address

PO BOX 848
SIOUX FALLS SD
57101-0848
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-3332
  • Fax:
Mailing address:
  • Phone: 605-339-6525
  • Fax: 605-339-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY J REILLY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 605-217-7246