Healthcare Provider Details

I. General information

NPI: 1972844793
Provider Name (Legal Business Name): SANFORD MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W 17TH ST STE 101
SIOUX FALLS SD
57104-8805
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-8040
  • Fax: 605-328-8054
Mailing address:
  • Phone: 605-328-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number100-1562
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number100-1562
License Number StateSD

VIII. Authorized Official

Name: TONY LEE MORRISON
Title or Position: VICE PRESIDENT, CHIEF REVENUE CYCLE
Credential:
Phone: 605-328-8380