Healthcare Provider Details

I. General information

NPI: 1922069368
Provider Name (Legal Business Name): SIBLEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 4TH AVE NW
ARLINGTON MN
55307-2075
US

IV. Provider business mailing address

601 WEST CHANDLER STREET P.O. BOX 620
ARLINGTON MN
55307-0620
US

V. Phone/Fax

Practice location:
  • Phone: 507-964-5669
  • Fax: 507-964-8460
Mailing address:
  • Phone: 507-964-2271
  • Fax: 507-964-8490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberFBL001293014326
License Number StateMN

VIII. Authorized Official

Name: TODD SANDBERG
Title or Position: CEO
Credential:
Phone: 507-964-8425