Provider Demographics
NPI: | 1346529211 |
---|---|
Name: | SANFORD CLINIC |
Entity Type: | Organization |
Organization Name: | SANFORD CLINIC |
Other - Org Name: | SANFORD CLINIC RADIATION ONCOLOGY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VICE PRESIDENT, REVENUE CYCLE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TONY |
Authorized Official - Middle Name: | LEE |
Authorized Official - Last Name: | MORRISON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 605-328-8380 |
Mailing Address - Street 1: | PO BOX 5074 |
Mailing Address - Street 2: | |
Mailing Address - City: | SIOUX FALLS |
Mailing Address - State: | SD |
Mailing Address - Zip Code: | 57117-5074 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 605-328-6585 |
Mailing Address - Fax: | 605-312-7611 |
Practice Address - Street 1: | 1309 W 17TH ST |
Practice Address - Street 2: | |
Practice Address - City: | SIOUX FALLS |
Practice Address - State: | SD |
Practice Address - Zip Code: | 57104-4663 |
Practice Address - Country: | US |
Practice Address - Phone: | 605-328-6001 |
Practice Address - Fax: | 605-328-6045 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-08-10 |
Last Update Date: | 2023-11-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |