Basic Information
Provider Information
NPI: 1326069097
EntityType: 2
ReplacementNPI:  
OrganizationName: SANFORD HEALTH NETWORK
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: SANFORD JACKSON MEDICAL CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5074
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571175074
CountryCode: US
TelephoneNumber: 6053286585
FaxNumber: 6053286512
Practice Location
Address1: 1430 NORTH HWY
Address2:  
City: JACKSON
State: MN
PostalCode: 561431093
CountryCode: US
TelephoneNumber: 5078472420
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/21/2006
LastUpdateDate: 02/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MORRISON
AuthorizedOfficialFirstName: TONY
AuthorizedOfficialMiddleName: LEE
AuthorizedOfficialTitleorPosition: VICE PRESIDENT, REVENUE CYCLE
AuthorizedOfficialTelephone: 6053288380
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282NC0060X331670MNN HospitalsGeneral Acute Care HospitalCritical Access
282NC0060X  Y HospitalsGeneral Acute Care HospitalCritical Access

ID Information
IDTypeStateIssuerDescription
30070305MN MEDICAID
502535001 MEDICAOTHER
2686801 SIOUX VALLEY HEALTH PLANOTHER
H31901 MIDLANDS CHOICEOTHER
092794705IA MEDICAID
1697HJA01 BLUE CROSS MNOTHER
45854530005MN MEDICAID


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