1528009412 NPI number — SANFORD MEDICAL CENTER FARGO

Table of content: (NPI 1528009412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528009412 NPI number — SANFORD MEDICAL CENTER FARGO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANFORD MEDICAL CENTER FARGO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SANFORD MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528009412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58107-2168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-234-2119
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 BROADWAY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58122-4520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORRISON
Authorized Official First Name:
TONY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
VICE PRESIDENT, REVENUE CYCLE
Authorized Official Telephone Number:
605-328-8380

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  5018A , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 735547500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4502269O9OO1 . This is a "TRICARE/TRIWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1006083 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 721 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5017664 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: O129720 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26941 . This is a "SIOUX VALLEY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103887 . This is a "CHOICE PLUS/PT CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 370579400 . This is a "FED WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: O1018 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017668100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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