1114953627 NPI number — SANFORD MEDICAL CENTER FARGO

Table of content: (NPI 1114953627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114953627 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:
Provider Other Organization Name Type Code:
6
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:
1114953627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2022
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:
218-863-6173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 E MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELICAN RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56572-4234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-863-6100
Provider Business Practice Location Address Fax Number:
218-863-6173
Provider Enumeration Date:
06/25/2006

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: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 517494500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com