=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407882780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANFORD HEALTH NETWORK NORTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 445 1ST ST E
-----------------------------------------------------
City | HALSTAD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56548-4142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-456-2158
-----------------------------------------------------
Fax | 218-456-2197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5074
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57117-5074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-328-6585
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT, REVENUE CYCLE
-----------------------------------------------------
Name | TONY LEE MORRISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-328-8380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------