Healthcare Provider Details

I. General information

NPI: 1083708267
Provider Name (Legal Business Name): SANFORD HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 3RD AVE S
CLEAR LAKE SD
57226-2016
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-874-2141
  • Fax: 605-874-3529
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number10533
License Number StateSD

VIII. Authorized Official

Name: STEVE GOETSCH
Title or Position: CFO
Credential:
Phone: 605-328-6940