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General NPI Number Information
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NPI Number | 1376617522
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Entity Type | Organization
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Legal Business Name | SANFORD HEALTH OF NORTHERN MINNESOTA
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1300 ANNE ST NW
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City | BEMIDJI
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State | MN
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Zip | 56601-5103
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Country | US
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Telephone | 218-751-5430
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Fax | 218-333-5566
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Provider Business Mailing Address
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Address Line | 1300 ANNE ST NW
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City | BEMIDJI
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State | MN
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Zip | 56601-5103
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Country | US
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Telephone | 218-751-5430
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Fax | 218-333-5566
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MR. JON F. BERGQUIST
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Credential |
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Telephone | 218-333-5514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 330837
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License Number State | MN
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