Healthcare Provider Details

I. General information

NPI: 1487741765
Provider Name (Legal Business Name): SANFORD HEALTHCARE ACCESSORIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 ANNE ST NW STE 1
BEMIDJI MN
56601-6152
US

IV. Provider business mailing address

PO BOX 9679
FARGO ND
58106-9679
US

V. Phone/Fax

Practice location:
  • Phone: 218-759-9391
  • Fax: 701-234-1366
Mailing address:
  • Phone: 701-234-1337
  • Fax: 701-234-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TONY LEE MORRISON
Title or Position: VICE PRESIDENT, REVENUE CYCLE
Credential:
Phone: 605-328-8380