NPIMap

Organization Active NPI

Sanford School of Medicine of the University of South Dakota Clinical

  • Clinical Medical Laboratory
  • Sioux Falls, SD
National Provider Identifier
1457578767
Registry record updated Oct 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
SANFORD SCHOOL OF MEDICINE OF THE UNIVERSITY OF SOUTH DAKOTA CLINICAL
Practice address
2501 W 22ND St
Sioux Falls, SD 57105-1305
Phone
(605) 333-5399
Fax
(605) 333-5399
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael R Koch, M.D.
Title
Dept. Chair
Phone
(605) 336-3230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X SD Primary

Addresses

Primary practice location

2501 W 22ND St
Sioux Falls, SD 57105-1305

Mailing address

1400 W 22ND St
Sioux Falls, SD 57105-1505
Phone (605) 357-1380

Other identifiers 3

IdentifierTypeStateIssuer
5580870MedicaidSD
0077920OtherSDBLUE CROSS AND BLUE SHIEL
0788018MedicaidIA

National Provider Directory

National Provider Directory
Tax ID family
SD Dept of HLTH Dba CHI35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191369600000",
    "number": "1457578767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 W 22ND ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051505",
            "telephone_number": "605-357-1380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W 22ND ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051305",
            "telephone_number": "605-333-5399",
            "fax_number": "605-333-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD SCHOOL OF MEDICINE OF THE UNIVERSITY OF SOUTH DAKOTA CLINICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2007-10-03",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DEPT. CHAIR",
        "authorized_official_telephone_number": "605-336-3230",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "SD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5580870",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "0077920",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0788018",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.