Healthcare Provider Details

I. General information

NPI: 1073520003
Provider Name (Legal Business Name): SANFORD MEDICAL CENTER FARGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 MAIN STREET
FORMAN ND
58032-0184
US

IV. Provider business mailing address

PO BOX 2168
FARGO ND
58107-2168
US

V. Phone/Fax

Practice location:
  • Phone: 701-724-3221
  • Fax: 701-724-3222
Mailing address:
  • Phone: 701-234-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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