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NPI Code Detail

MEDICARE: SANFORD CLINIC

MEDICARE: SANFORD CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326054784
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANFORD CLINIC
Provider Business Mailing Address
First Line : PO BOX 5074
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57117-5074
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2701 S KIWANIS AVE
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57105-4252
Country : US
Telephone Number : 605-328-2883
Fax Number : 605-328-9101
Authorized Official
Title or Position : CFO
Name : STEVE GOETSCH
Credential :
Telephone Number : 605-328-6940
Provider Enumeration Date : 07/31/2006
Last Update Date : 11/27/2023

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Directions to “SANFORD CLINIC ” Practice Location

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