1073166674 NPI number — SANFORD HEALTH OF NORTHERN MINNESOTA

Table of content: (NPI 1073166674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073166674 NPI number — SANFORD HEALTH OF NORTHERN MINNESOTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANFORD HEALTH OF NORTHERN MINNESOTA
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:
Provider Other Organization Name Type Code:
6
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:
1073166674
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:
605-328-8311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 1ST ST NW
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BLACKDUCK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56630-0188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-835-7700
Provider Business Practice Location Address Fax Number:
218-835-2030
Provider Enumeration Date:
07/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
KUNKEL
Authorized Official First Name:
JOANN
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
605-312-6549

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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