MEDICARE: SANFORD HEALTH OF NORTHERN MINNESOTA

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
1	314000000X	Skilled Nursing Facility	326619	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1538ENO	OTHER	MN	BLUE CROSS/BLUE SHIELD MN

General Provider Information

NPI Number	:	1659376663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANFORD HEALTH OF NORTHERN MINNESOTA

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:	605-328-6585
Fax Number	:	605-312-9802

Provider Business Practice Location Address
First Line	:	1000 ANNE ST NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5109
Country	:	US
Telephone Number	:	218-751-0220
Fax Number	:	218-333-6514

Authorized Official
Title or Position	:	VP, REVENUE CYCLE
Name	:	TONY LEE MORRISON
Credential	:
Telephone Number	:	605-328-8380

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	06/02/2023

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Directions to “SANFORD HEALTH OF NORTHERN MINNESOTA ” Practice Location

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