1801977335 NPI number — SANFORD HEALTH NETWORK

Table of content: (NPI 1801977335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801977335 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:
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:
1801977335
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:
118 N. 7TH AVE
Provider Second Line Business Mailing Address:
P.O. BOX 250
Provider Business Mailing Address City Name:
SHELDON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51201-0250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-324-5041
Provider Business Mailing Address Fax Number:
712-324-6025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 N 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELDON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51201-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-324-5041
Provider Business Practice Location Address Fax Number:
712-324-6025
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
712-324-5041

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , with the licence number:  905 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1618783 . This is a "NABP NUMBER" identifier . This identifiers is of the category "OTHER".




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