Healthcare Provider Details

I. General information

NPI: 1831265727
Provider Name (Legal Business Name): SANFORD CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S EUCLID AVE SUITE 201
SIOUX FALLS SD
57105-7700
US

IV. Provider business mailing address

1201 S EUCLID AVE SUITE 201
SIOUX FALLS SD
57105-7700
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-8260
  • Fax: 605-328-8261
Mailing address:
  • Phone: 605-328-8260
  • Fax: 605-328-8261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

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