Provider Demographics
NPI:1366528424
Name:SANFORD HEALTH NETWORK
Entity type:Organization
Organization Name:SANFORD HEALTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO SANFORD HEALTH NETWORK
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-328-5506
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:1401 WEST 1ST STREET
Mailing Address - City:WEBSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57274-0489
Mailing Address - Country:US
Mailing Address - Phone:605-345-3336
Mailing Address - Fax:605-345-2402
Practice Address - Street 1:1401 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:SD
Practice Address - Zip Code:57274-1054
Practice Address - Country:US
Practice Address - Phone:605-345-3336
Practice Address - Fax:605-345-2402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANFORD HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-31
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10573335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9165052Medicaid
SD0403210003Medicare NSC