Healthcare Provider Details

I. General information

NPI: 1780412858
Provider Name (Legal Business Name): SANFORD HEALTH PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CHERAPA PL STE 201
SIOUX FALLS SD
57103-2272
US

IV. Provider business mailing address

300 CHERAPA PL STE 201
SIOUX FALLS SD
57103-2272
US

V. Phone/Fax

Practice location:
  • Phone: 605-328-6868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DYLAN WHEELER
Title or Position: HEAD OF GOVERNMENT AFFAIRS
Credential: JD
Phone: 605-328-7186