Basic Information
| Provider Information | |||||||||
| NPI: | 1831103449 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SANFORD HEALTH NETWORK | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SANFORD HOSPITAL WEBSTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5074 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053286585 | ||||||||
| FaxNumber: | 6503286512 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 W 1ST ST | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572741054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053453336 | ||||||||
| FaxNumber: | 6053452402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MORRISON | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 6053288380 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 10573 | SD | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 5000158 | 01 | TX | MEDICA | OTHER | 81311 | 01 | SD | BLUE CROSS HOSPITAL | OTHER | 5500502 | 05 | SD | OUTPATIENT HOSPITAL | MEDICAID | 64360 | 01 | MN | HEALTH PARTNERS | OTHER | 8022861 | 01 | MN | PREFERRED ONE | OTHER | 0100502 | 05 | SD | INPATIENT HOSPITAL | MEDICAID | H320 | 01 | NE | MIDLAND CHOICE | OTHER | 2940001 | 01 | SD | SANFORD HEALTH PLAN | OTHER |