1851805667 NPI number — SANFORD ABERDEEN MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851805667 NPI number — SANFORD ABERDEEN MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANFORD ABERDEEN MEDICAL CENTER
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:
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:
1851805667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2905 3RD AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57401-5420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-626-4380
Provider Business Mailing Address Fax Number:
605-626-4381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2905 3RD AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57401-5420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-626-4380
Provider Business Practice Location Address Fax Number:
605-626-4381
Provider Enumeration Date:
12/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HAGEN
Authorized Official First Name:
ABBIE
Authorized Official Middle Name:
LINNEA
Authorized Official Title or Position:
CERTIFIED OCCUPATIONAL THERAPY ASST
Authorized Official Telephone Number:
605-626-4380

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , with the licence number:  362A , 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)





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