Healthcare Provider Details

I. General information

NPI: 1376617522
Provider Name (Legal Business Name): SANFORD HEALTH OF NORTHERN MINNESOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ANNE ST NW
BEMIDJI MN
56601-5103
US

IV. Provider business mailing address

1300 ANNE ST NW
BEMIDJI MN
56601-5103
US

V. Phone/Fax

Practice location:
  • Phone: 218-751-5430
  • Fax: 218-333-5566
Mailing address:
  • Phone: 218-751-5430
  • Fax: 218-333-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number330837
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JON F. BERGQUIST
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 218-333-5514