Healthcare Provider Details

I. General information

NPI: 1053792465
Provider Name (Legal Business Name): SANFORD CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 11/27/2023
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E 54TH ST N STE 200
SIOUX FALLS SD
57104-0686
US

IV. Provider business mailing address

2603 E BROADWAY AVE
BISMARCK ND
58501-5107
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-8170
  • Fax:
Mailing address:
  • Phone: 701-323-8307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

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