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NPI Code Detail

MEDICARE: SIOUXLAND REGIONAL CANCER CENTER

MEDICARE: SIOUXLAND REGIONAL CANCER CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician
2332B00000XDurable Medical Equipment & Medical Supplies
3207RH0003XHematology & Oncology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
350928OTHERIAWELLMARK

General Provider Information

NPI Number : 1114904604
Entity Type Code : Organization
Provider Name (Legal Business Name) : SIOUXLAND REGIONAL CANCER CENTER
Provider Business Mailing Address
First Line : PO BOX 5017
Second Line :
City : SIOUX CITY
State : IA
Zip : 51102-5017
Country : US
Telephone Number : 712-252-9301
Fax Number : 712-252-9337
Provider Business Practice Location Address
First Line : 230 NEBRASKA ST
Second Line :
City : SIOUX CITY
State : IA
Zip : 51101-1733
Country : US
Telephone Number : 712-252-0088
Fax Number : 712-252-9404
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. KRISTA J MCCULLOUGH
Credential :
Telephone Number : 712-252-9301
Provider Enumeration Date : 12/27/2005
Last Update Date : 06/24/2019

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Directions to “SIOUXLAND REGIONAL CANCER CENTER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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