SANFORD CLINIC (NPI# 1770518037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770518037 |
| Entity Type | Organization |
| Organization Name | SANFORD CLINIC |
| Other Organization Name | SANFORD CANCER CENTER - ONCOLOGY CLINIC |
| Practice Address |
1309 W 17th St Ste 101 Sioux Falls SD 57104-8805 |
| Mailing Address |
Po Box 5074 Sioux Falls SD 57117-5074 |
| Practice Telephone | 6053288000 |
| Practice Fax Number | 6053288001 |
| Mailing Telephone | 6053286585 |
| Mailing Fax Number | 6053287177 |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2020-07-06 |
| Authorized Official Name | TONY LEE MORRISON (VICE PRESIDENT, REVENUE CYCLE) |
| Authorized Official Telephone | 6053288380 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 364S00000X | Clinical Nurse Specialist | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 364SX0200X |
Clinical Nurse Specialist Specialization: Oncology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0537886 | 05 | |
| MN | 281988100 | 05 |
| Other Name | Type Code |
|---|---|
| Sanford Cancer Center - Oncology Clinic | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 20 S Plum St, Vermillion, SD 570693346 | 6053288000 | 6053288001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164069506 | Sanford Clinic | Clinic/Center | 2310 S Marion Rd Ste 140, Sioux Falls, SD 57106-1144 | 2019-12-04 |
| 1457995714 | Sanford Clinic | Clinic/Center | 1112 S Lake Ave, Ste 201, Sioux Falls, SD 57104 | 2019-10-30 |
| 1356983175 | Sanford Clinic | Clinic/Center | 366 Hillsboro Technology Dr, Deerfield Beach, FL 33441-1836 | 2019-10-14 |
| 1427555002 | Sanford Clinic | Family Medicine | 136 S Phillips Ave Ste 102, Sioux Falls, SD 57104 | 2018-04-10 |
| 1396089900 | Sanford Clinic | Nurse Practitioner | 1309 W 17th St Ste 102, Sioux Falls, SD 57104-4663 | 2012-11-20 |
| 1740416395 | Sanford Clinic | Pediatrics | 2502 W. Elk Ave., Duncan, OK 73533 | 2009-06-09 |
| 1861685166 | Sanford Clinic | Radiology | 891 14th Ave Ne, Watertown, SD 57201 | 2007-08-21 |
| 1366635740 | Sanford Clinic | Family Medicine | 433 Kansas Ave Se, Huron, SD 57350-2561 | 2007-08-20 |
| 1922123108 | Sanford Clinic | Clinic/Center | 703 S Broadway, Watertown, SD 57201 | 2007-03-20 |
| 1285738997 | Sanford Clinic | Obstetrics & Gynecology | 1201 S Euclid Ave Ste 201, Sioux Falls, SD 57105-0434 | 2006-09-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SANFORD CLINIC | 1305 W 18th St, Sioux Falls, SD 57105-0401 |
| Colorado Business Entities | Sanford Clinic | 1305 W 18th St, Sioux Falls, SD 57105 |
| Iowa Business Entities | SANFORD CLINIC | 1305 W 18th St, Sioux Falls, SD 57105 |
| Oklahoma Business Registrations | SANFORD CLINIC | 1305 W 18th St, Sioux Falls, SD 57105 |
| Iowa Business Entities | SANFORD CLINIC NORTH | 801 Broadway North, Fargo, ND 58122 |
| System for Award Management (SAM) Entities | SANFORD CLINIC NORTH FARGO | 801 Broadway N, Fargo, ND 58102-3641 |
| Street Address |
1309 W 17TH ST STE 101 |
| City | SIOUX FALLS |
| State | SD |
| Zip Code | 57104-8805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437155140 | Miroslaw A Mazurczak | Internal Medicine | 1309 W 17th St, Ste 101, Sioux Falls, SD 57104-8805 | 2005-06-27 |
| 1164064226 | Kimberly Caye Niemann | Nurse Practitioner | 1309 W 17th St, Sioux Falls, SD 57104-4663 | 2019-10-10 |
| 1982160206 | Marin Melissa Schaefer | Nurse Practitioner | 1309 W 17th St, Sioux Falls, SD 57104-4663 | 2019-02-11 |
| 1992299614 | Kelly Anne Tolley | Nurse Practitioner | 1309 W 17th St, Sioux Falls, SD 57104-4663 | 2018-06-16 |
| 1881190312 | Emily Joy Hutchinson | Counselor | 1309 W 17th St, Sioux Falls, SD 57104-4663 | 2018-04-03 |
| 1003366055 | Sanford Home Medical Equipment | Durable Medical Equipment & Medical Supplies | 1309 W 17th St, Ste G403c, Sioux Falls, SD 57104-4663 | 2016-10-13 |
| 1497127005 | Kimberly Rae Hamer | Nurse Practitioner | 1309 W 17th St, Ste 101, Sioux Falls, SD 57104-4663 | 2015-10-22 |
| 1023426350 | Heather Casper-mclay | Nurse Practitioner | 1309 W 17th St, Suite 101, Sioux Falls, SD 57104-4663 | 2014-07-30 |
| 1497163026 | Sanford Clinic | Family Medicine | 1309 W 17th St, Ste G01, Sioux Falls, SD 57104-4663 | 2014-07-28 |
| 1285906156 | Larissa L Risty | Genetic Counselor, MS | 1309 W 17th St, Sioux Falls, SD 57104-4663 | 2012-02-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518594134 | Melissa Bader | Nurse Practitioner | 1112 S. Lake Ave, Suite 201, Sioux Falls, SD 57104 | 2020-03-24 |
| 1457995714 | Sanford Clinic | Clinic/Center | 1112 S Lake Ave, Ste 201, Sioux Falls, SD 57104 | 2019-10-30 |
| 1427555002 | Sanford Clinic | Family Medicine | 136 S Phillips Ave Ste 102, Sioux Falls, SD 57104 | 2018-04-10 |
| 1033637210 | Anna Peasley | Speech-Language Pathologist | 710 W 18th St, Sioux Falls, SD 57104 | 2017-09-07 |
| 1699204313 | Sioux Falls Primary Home Care Services LLC | In Home Supportive Care | 201 N Minnesota Ave Ste 101l, Sioux Falls, SD 57104 | 2017-06-06 |
| 1093258808 | Megan Regina Wexler | Social Worker | 4510 N Lewis Ave, Sioux Falls, SD 57104 | 2016-11-28 |
| 1831645498 | Ryan Ortiz | Specialist/Technologist | 1908 1/2 Old Town Rd Nw, Albuquerque, NM 57104 | 2016-09-01 |
| 1881140622 | Kristine Carol Smith | Occupational Therapist | 601 N. Spring Ave, Hawthorne Elementary, Sioux Falls, SD 57104 | 2016-08-31 |
| 1215299292 | Jolene Mitchell | Preventive Medicine | 900 E 54th St N Ste 100, Sioux Falls, SD 57104 | 2012-06-14 |
| 1871874651 | Christine Marie Burg | Pharmacist | 2503 East 54th Street N., Medvantx Pharmacy Services, Sioux Falls, SD 57104 | 2011-09-07 |
| Find all providers in zip 57104 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184935652 | Houman Nourkeyhani | Internal Medicine | 1000 E 23rd St Ste 230, Sioux Falls, SD 57105-2122 | 2010-06-29 |
| 1124017256 | Michael Stephen Mchale | Internal Medicine | 1000 E. 23rd St., Ste. 230, Sioux Falls, SD 57105-2122 | 2005-10-20 |
| 1437155140 | Miroslaw A Mazurczak | Internal Medicine | 1309 W 17th St, Ste 101, Sioux Falls, SD 57104-8805 | 2005-06-27 |
| 1164780201 | Avera Mckennan | Internal Medicine | 3720 W 69th St, Sioux Falls, SD 57108-8192 | 2012-04-26 |
| 1174686547 | Brian Leyland-jones | Internal Medicine | 1000 E 23rd St, Suite 200, Sioux Falls, SD 57105-2108 | 2006-12-18 |
| 1235196056 | Mchale Institute, P.C. | Internal Medicine | 3720 W 69th St, Sioux Falls, SD 57108 | 2006-04-26 |
| 1538135447 | Avera Mckennan | Internal Medicine | 1000 E. 23rd St., Ste. 200, Sioux Falls, SD 57105-2122 | 2006-02-28 |
| 1295701522 | Kelly George Mccaul | Internal Medicine | 1000 E. 23rd St., Ste. 200, Sioux Falls, SD 57105-2122 | 2006-02-27 |
| 1013983352 | Vinod Parameswaran | Internal Medicine | 1000 E. 23rd St., Ste. 200, Sioux Falls, SD 57105-2122 | 2006-02-27 |
| 1750357299 | Mark R Huber | Internal Medicine | 1000 E. 23rd St., Ste. 230, Sioux Falls, SD 57105-2122 | 2006-02-24 |
| Find all providers in SIOUX FALLS | ||||
| City | SIOUX FALLS |
| Zip Code | 57104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.