Healthcare Provider Details

I. General information

NPI: 1801840632
Provider Name (Legal Business Name): SANFORD CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/27/2023
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 4TH ST NW
WATERTOWN SD
57201-0290
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8471
  • Fax: 605-886-9317
Mailing address:
  • Phone: 605-328-6585
  • Fax: 605-328-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily 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