1780781054 NPI number — SANFORD HEALTH NETWORK

Table of content: (NPI 1780781054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780781054 NPI number — SANFORD HEALTH NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANFORD HEALTH NETWORK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SANFORD CANBY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780781054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5074
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57117-5074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-328-6585
Provider Business Mailing Address Fax Number:
605-328-6512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 SAINT OLAF AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANBY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56220-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-223-7277
Provider Business Practice Location Address Fax Number:
507-223-7465
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORRISON
Authorized Official First Name:
TONY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
VICE PRESIDENT, REVENUE CYCLE
Authorized Official Telephone Number:
605-328-8380

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  330738 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300701 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16264 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26866 . This is a "SIOUX VALLEY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660253300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01014228 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0120020 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5025366 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1599HCA . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".