NPIMap

Organization Active NPI

Sioux Valley Regional Health Services

Doing business as Sioux Valley Lake Park Clinic

  • Nurse Practitioner
  • Lake Park, IA
National Provider Identifier
1619050929
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
SIOUX VALLEY REGIONAL HEALTH SERVICES
Doing business as
Sioux Valley Lake Park Clinic
Practice address
204 Market St.
Lake Park, IA 51347
Phone
(712) 832-9559
Fax
(712) 832-3801
NPI assigned
Oct 23, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joel Mason Gustafson
Title
Administrator
Phone
(712) 324-5356

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

204 Market St.
Lake Park, IA 51347

Mailing address

204 Market St.
P.O. Box 627
Lake Park, IA 51347
Phone (712) 832-9559

Other names 1

  • Sioux Valley Lake Park Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Canby Community Health49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

Organizations that report the same tax identification number in the National Provider Directory.

View all 48

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619050929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MARKET ST.",
            "address_2": "P.O. BOX 627",
            "city": "LAKE PARK",
            "state": "IA",
            "postal_code": "51347",
            "telephone_number": "712-832-9559",
            "fax_number": "712-832-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MARKET ST.",
            "city": "LAKE PARK",
            "state": "IA",
            "postal_code": "51347",
            "telephone_number": "712-832-9559",
            "fax_number": "712-832-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUX VALLEY REGIONAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "MASON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "712-324-5356"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sioux Valley Lake Park Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Park, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.