Provider Demographics
NPI:1770849697
Name:SANFORD HEALTH OF NORTHERN MINNESOTA
Entity Type:Organization
Organization Name:SANFORD HEALTH OF NORTHERN MINNESOTA
Other - Org Name:SANFORD HEALTH KELLIHER CLINIC
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 1:345 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:KELLIHER
Mailing Address - State:MN
Mailing Address - Zip Code:56650
Mailing Address - Country:US
Mailing Address - Phone:218-647-8832
Mailing Address - Fax:218-647-8127
Practice Address - Street 1:243 CLARK AVE N
Practice Address - Street 2:
Practice Address - City:KELLIHER
Practice Address - State:MN
Practice Address - Zip Code:56650-3015
Practice Address - Country:US
Practice Address - Phone:218-647-8832
Practice Address - Fax:218-647-8127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2022-08-04
Deactivation Date:2022-05-18
Deactivation Code:
Reactivation Date:2022-06-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty