Provider Demographics
NPI:1841242542
Name:SANFORD MEDICAL CENTER
Entity Type:Organization
Organization Name:SANFORD MEDICAL CENTER
Other - Org Name:SANFORD LABORATORIES
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:605-328-5485
Mailing Address - Fax:605-328-5453
Practice Address - Street 1:2301 E 60TH ST N
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0569
Practice Address - Country:US
Practice Address - Phone:605-328-5485
Practice Address - Fax:605-328-5453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANFORD MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0590984Medicaid
MT0421617Medicaid
WY123109000Medicaid
SD5580530Medicaid
MN690000057Medicare PIN
SDS3793Medicare UPIN
SD5580530Medicaid