# SIOUX VALLEY REGIONAL HEALTH SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sioux Valley Lake Park Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619050929
- **Authorized official:** JOEL MASON GUSTAFSON (ADMINISTRATOR)
- **Authorized official phone:** (712) 324-5356

## Contact information

- **Practice address:** 204 MARKET ST., LAKE PARK, IA 51347
- **Practice address phone:** (712) 832-9559
- **Practice address fax:** (712) 832-3801
- **Mailing address:** 204 MARKET ST., P.O. BOX 627, LAKE PARK, IA 51347
- **Mailing address phone:** (712) 832-9559
- **Mailing address fax:** (712) 832-3801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0689091 | — | IA |