Provider Demographics
NPI:1922069368
Name:SIBLEY MEDICAL CENTER
Entity type:Organization
Organization Name:SIBLEY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-964-8425
Mailing Address - Street 1:601 WEST CHANDLER STREET
Mailing Address - Street 2:P.O. BOX 620
Mailing Address - City:ARLINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55307-0620
Mailing Address - Country:US
Mailing Address - Phone:507-964-2271
Mailing Address - Fax:507-964-8490
Practice Address - Street 1:105 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MN
Practice Address - Zip Code:55307-2075
Practice Address - Country:US
Practice Address - Phone:507-964-5669
Practice Address - Fax:507-964-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNFBL001293014326261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN513547800Medicare ID - Type UnspecifiedHOSPITAL MEDICAID NUMBER
FM241311Medicare Oscar/Certification