MEDICARE: SANFORD CLINIC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1619990603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANFORD CLINIC

Provider Business Mailing Address
First Line	:	410 N CLIFF AVE
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032-2253
Country	:	US
Telephone Number	:	605-743-5199
Fax Number	:	605-743-5378

Provider Business Practice Location Address
First Line	:	410 N CLIFF AVE
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032-2253
Country	:	US
Telephone Number	:	605-743-5199
Fax Number	:	605-743-5378

Authorized Official
Title or Position	:	CFO
Name	:	STEVE GOETSCH
Credential	:
Telephone Number	:	605-328-6940

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	12/03/2008

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Directions to “SANFORD CLINIC ” Practice Location

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