| Sanford Clinic Mountain Lake | |
|
308 8th St N Mountain Lake MN 56159-1568 | |
| (507) 427-3332 | |
| (507) 427-2493 |
| Full Name | Sanford Clinic Mountain Lake |
|---|---|
| Speciality | Clinic/Center |
| Location | 308 8th St N, Mountain Lake, Minnesota |
| Authorized Official Name and Position | Tony Lee Morrison (VICE PRESIDENT, REVENUE CYCLE) |
| Authorized Official Contact | 6053288380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sanford Clinic Mountain Lake Po Box 5074 Sioux Falls SD 57117-5074 Ph: (605) 328-6585 | Sanford Clinic Mountain Lake 308 8th St N Mountain Lake MN 56159-1568 Ph: (507) 427-3332 |
| NPI Number | 1568469039 |
|---|---|
| Provider Enumeration Date | 06/30/2005 |
| Last Update Date | 11/29/2022 |
| Medicare PECOS PAC ID | 6800707100 |
|---|---|
| Medicare Enrollment ID | O20230104003082 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568469039 | NPI | - | NPPES |
| 958132400 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Sioux Valley Clinic Mountain Lake Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 308 8th St N, Mountain Lake, MN 56159 Phone: 507-427-3332 |