1134140825 NPI number — SANFORD HEALTH NETWORK

Table of content: MR. TIMOTHY HARRIS PSYCH TECH (NPI 1457024234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134140825 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 CHAMBERLAIN 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:
1134140825
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:
605-328-8303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S BYRON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMBERLAIN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57325-9741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-234-5511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006

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:  50302 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5500910 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26869 . This is a "SIOUX VALLEY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80018 . This is a "BLUE CROSS SD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0100910 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5000230 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: H321 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".




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