Healthcare Provider Details

I. General information

NPI: 1518061803
Provider Name (Legal Business Name): SANFORD HEALTH NETWORK NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 11/27/2023
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 6TH AVE SE
MAYVILLE ND
58257-1506
US

IV. Provider business mailing address

PO BOX 2168
FARGO ND
58107-2168
US

V. Phone/Fax

Practice location:
  • Phone: 701-788-3800
  • Fax: 701-788-2145
Mailing address:
  • Phone: 701-234-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number5034
License Number StateND

VIII. Authorized Official

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