Basic Information
| Provider Information | |||||||||
| NPI: | 1497703045 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SANFORD HEALTH NETWORK | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SANFORD LUVERNE MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5074 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053286585 | ||||||||
| FaxNumber: | 6053286512 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N KNISS AVE | ||||||||
| Address2: | |||||||||
| City: | LUVERNE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072832321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
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| AuthorizedOfficialLastName: | MORRISON | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 6053288380 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 331674 | MN | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 78774 | 01 | HEALTH PARTNERS | OTHER | 121122950 | 05 | MN | MEDICAID | 5520772 | 05 | SD | MEDICAID | 56156 | 01 | TRICARE WEST | OTHER | 0539619 | 05 | IA | MEDICAID | 5G50HLU | 01 | MNBCBS HOSPITAL | OTHER | 01010035 | 01 | PREFERREDONE/CIGNA | OTHER | 300551 | 05 | MN | MEDICAID | 55651 | 01 | SIOUX VALLEY HEALTH PLAN | OTHER | 0120772 | 05 | SD | MEDICAID | 11467 | 05 | ND | MEDICAID | 204132400 | 01 | US DEPT OF LABOR | OTHER | 71614500 | 05 | MN | MEDICAID | 9001650 | 05 | SD | MEDICAID | 21321 | 01 | AMERICAS PPO | OTHER | 242547500 | 05 | MN | MEDICAID | 430068 | 01 | DAKOTACARE | OTHER | 470665000 | 05 | MN | MEDICAID |