Healthcare Provider Details

I. General information

NPI: 1558458844
Provider Name (Legal Business Name): SANFORD MEDICAL CENTER FARGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S UNIVERSITY DRIVE
FARGO ND
58103-4940
US

IV. Provider business mailing address

1720 S UNIVERSITY DRIVE
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 701-280-4469
  • Fax: 701-280-4643
Mailing address:
  • Phone: 701-234-2121
  • Fax: 701-280-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number539
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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