NPIMap

Organization Active NPI

Siouxland Community Health Center

  • Clinic Pharmacy
  • Sioux City, IA
National Provider Identifier
1700967833
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
Legal business name
SIOUXLAND COMMUNITY HEALTH CENTER
Practice address
1021 Nebraska Street
Sioux City, IA 51104
Phone
(712) 255-4204
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Authorized official

Name
Mark Donaldson
Title
Ceo
Phone
(712) 226-9010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X Primary

Addresses

Primary practice location

1021 Nebraska Street
Sioux City, IA 51104

Mailing address

1021 Nebraska St
Sioux City, IA 51105-1436
Phone (712) 255-4204

Other identifiers 3

IdentifierTypeStateIssuer
5355000MedicaidSD
0264432MedicaidIA
1700967833MedicaidIA

Other names 1

  • Siouxland Community Health Center Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230517002816 IA DME Supplier - Pharmacy 9931099546 Practice locations: Sioux City, IA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Siouxland Community HLT5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Siouxland Community Health Center South Sioux City ClinicSouth Sioux City, NE, CCN 281840 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 1, 2015
Dec 1, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785974400000",
    "number": "1700967833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 NEBRASKA ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051436",
            "telephone_number": "712-255-4204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 NEBRASKA STREET",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "51104",
            "telephone_number": "712-255-4204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIOUXLAND COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "712-226-9010"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5355000",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0264432",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700967833",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Siouxland Community Health Center Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sioux City, IA

Sources for this page

Verify at the official NPI Registry.