=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720278278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTH CARE OF SIOUXLAND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2007
-----------------------------------------------------
Last Update Date | 05/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 MAIN ST
-----------------------------------------------------
City | MOVILLE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51039-7715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-873-5225
-----------------------------------------------------
Fax | 712-873-5206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 814 PIERCE ST SUITE 102
-----------------------------------------------------
City | SIOUX CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51101-1058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-226-2600
-----------------------------------------------------
Fax | 712-226-2605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHANIN C MCCABE-HARDING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 712-226-2600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------