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General NPI Number Information
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NPI Number | 1831131234
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Entity Type | Organization
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Legal Business Name | SANFORD MEDICAL CENTER FARGO
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 410 4TH ST NW
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City | MAHNOMEN
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State | MN
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Zip | 56557-4208
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Country | US
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Telephone | 218-935-2514
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Fax | 218-935-2720
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Provider Business Mailing Address
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Address Line | PO BOX 2168
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City | FARGO
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State | ND
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Zip | 58107-2168
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Country | US
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Telephone | 701-234-2119
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT, REVENUE CYCLE
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Name | TONY LEE MORRISON
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Credential |
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Telephone | 605-328-8380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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