Sanford Clinic
Organization Active NPI Family Medicine Physician · Hartford, SD
NPI 1700809795 · NPPES record last updated Jul 6, 2020
Key facts
- NPI
- 1700809795
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SANFORD CLINIC
- Practice address
- 905 N Oaks Ave
Hartford, SD 57033-6358 - Phone
- (605) 528-3725
- Fax
- (605) 528-3741
- NPI assigned
- Jul 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Tony Lee Morrison
- Title
- Vice President, Revenue Cycle
- Phone
- (605) 328-8380
Practitioners 4
-
Scott W Ecklund, MD
-
Thomas H Flesher III, M.D.
-
Rose Marie Hoiten, CNM,CNP,IBCLC
-
Brenna L Tate, CNM
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 43D2130382 | Sanford Clinic Hartford | Provider-performed microscopy | May 7, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000532 | SD | Part B Supplier - Clinic/Group Practice | 0244143824 |
Receives reassigned benefits from 941 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
905 N Oaks Ave
Hartford, SD 57033-6358
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585
Other names
- Sanford Clinic Family Medicine Hartford
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All providers in Hartford, SD · Family Medicine Physician in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.