Organization
PRAIRIE PEDIATRICS, PC
Active
Other names
Prairie Pediatrics & Adolescent Clinic, PC
Organization subpart
No
Provider details
NPI number
Authorized official
MELANIE OLSEN (BUSINESS MANAGER)
(712) 255-8901
Entity
Organization
Contact information
Practice address
1125 PIERCE ST, SIOUX CITY, IA 51105-1485
(712) 255-8901
(712) 255-9161
Mailing address
1125 PIERCE ST, SIOUX CITY, IA 51105-1485
(712) 255-8901
(712) 255-9161
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51104A001
TRICARE ENTITY ID
IA
Enumeration date
10/25/2006
Last updated
01/27/2015
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