Healthcare Provider Details

I. General information

NPI: 1598852972
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: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 1ST ST SW
MINOT ND
58701-3837
US

IV. Provider business mailing address

PO BOX 9679
FARGO ND
58106-9679
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-4110
  • 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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier17124
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHPARTNERS
# 2
Identifier1043597
Identifier TypeOTHER
Identifier State
Identifier IssuerPREFERRED ONE
# 3
Identifier141890100
Identifier TypeOTHER
Identifier State
Identifier IssuerFED WORKERS COMP
# 4
Identifier297G7HE
Identifier TypeOTHER
Identifier State
Identifier IssuerMNBC
# 5
Identifier320402200
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 6
Identifier9163333
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 7
Identifier70509
Identifier TypeOTHER
Identifier State
Identifier IssuerNDBC - NUTRITION THERAPY
# 8
Identifier55082
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer
# 9
Identifier7880
Identifier TypeOTHER
Identifier State
Identifier IssuerNDBC
# 10
Identifier8214538
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICA

VIII. Authorized Official

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