Provider Demographics
NPI:1245300557
Name:SANFORD HEALTH NETWORK
Entity type:Organization
Organization Name:SANFORD HEALTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-472-3716
Mailing Address - Street 1:803 S GREENE ST
Mailing Address - Street 2:
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-1948
Mailing Address - Country:US
Mailing Address - Phone:712-472-3716
Mailing Address - Fax:712-472-2878
Practice Address - Street 1:803 S GREENE ST
Practice Address - Street 2:
Practice Address - City:ROCK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-1948
Practice Address - Country:US
Practice Address - Phone:712-472-3716
Practice Address - Fax:712-472-2878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANFORD HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0250498Medicaid
IA0638700Medicaid
IA0250498Medicaid
IA168507Medicare ID - Type UnspecifiedMEDICARE RHC #