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PIERCE STREET SAME DAY SURGERY LC NPI 1205030731


NPI Information

NPI: 1205030731
Provider Name: PIERCE STREET SAME DAY SURGERY, LC

Former Legal Business Name: PIERCE STREET SAME DAY SURGERY, LC

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 16D1070291

Address:
2730 PIERCE ST
SIOUX CITY, IA
ZIP 51104
Phone: (712) 294-7773
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PIERCE STREET SAME DAY SURGERY, LC is an ambulatory surgical clinic center in Sioux City, IA. PIERCE STREET SAME DAY SURGERY, LC NPI is 1205030731. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Pierce Street Same Day Surgery, Lc.

The provider's business location address is:

2730 PIERCE ST
SIOUX CITY, IA
ZIP 51104-796
Phone: (712) 294-7773
Fax: (712) 279-7958

The provider's authorized official is Craig Bryan .
The authorized official title is Chief Executive Officer and has the following contact phone number (712) 294-8911.

The CLIA number assigned to this NPI record is 16D1070291 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/11/2007 and was last updated on 11/18/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QA1903XClinic/CenterAmbulatory SurgicalYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
110025588200MEDICAIDNEBRASKA
21205030731MEDICAIDIOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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