Provider Demographics
NPI:1588834501
Name:SANFORD CLINIC
Entity Type:Organization
Organization Name:SANFORD CLINIC
Other - Org Name:SANFORD CANCER CENTER ONCOLOGY CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF CLINIC OPER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-328-8033
Mailing Address - Street 1:1309 W 17TH ST
Mailing Address - Street 2:#101
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-4663
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1309 W 17TH ST
Practice Address - Street 2:#101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4663
Practice Address - Country:US
Practice Address - Phone:605-328-8000
Practice Address - Fax:605-328-8054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3341332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
4354077OtherOTHER ID NUMBER