MEDICARE: SANFORD MEDICAL CENTER FARGO

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	291U00000X	Clinical Medical Laboratory
2	261QD0000X	Dental Clinic/Center
3	207L00000X	Anesthesiology Physician
4	207P00000X	Emergency Medicine Physician
5	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)
6	111N00000X	Chiropractor
7	207R00000X	Internal Medicine Physician
8	207X00000X	Orthopaedic Surgery Physician
9	261Q00000X	Clinic/Center
10	225X00000X	Occupational Therapist
11	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
12	208000000X	Pediatrics Physician
13	207V00000X	Obstetrics & Gynecology Physician
14	208600000X	Surgery Physician
15	207Q00000X	Family Medicine Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DR6521	OTHER	ND	RR MEDICARE
3	DR6518	OTHER	MN	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	370579402	OTHER	ND	FEDERAL WORKERS COMP

NPI Number	:	1184917924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANFORD MEDICAL CENTER FARGO

Provider Business Mailing Address
First Line	:	PO BOX 2168
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58107-2168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 SHEYENNE ST
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-2637
Country	:	US
Telephone Number	:	701-234-4445
Fax Number	:

Authorized Official
Title or Position	:	VP, CHIEF REVENUE CYCLE OFFICER
Name	:	TONY LEE MORRISON
Credential	:
Telephone Number	:	605-328-8380

Provider Enumeration Date	:	05/26/2011
Last Update Date	:	06/08/2026

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308