MEDICARE: SANFORD BISMARCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8623	OTHER	ND	BLUE CROSS FT YATES DIALY

General Provider Information

NPI Number	:	1396828547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANFORD BISMARCK

Provider Business Mailing Address
First Line	:	300 N 7TH ST
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58501-4439
Country	:	US
Telephone Number	:	701-323-6000
Fax Number	:	701-323-5221

Provider Business Practice Location Address
First Line	:	#10 N RIVER RD
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538
Country	:	US
Telephone Number	:	701-854-7553
Fax Number	:	701-323-2801

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL R SCHUMACHER
Credential	:
Telephone Number	:	701-323-6130

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	01/23/2025

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Directions to “SANFORD BISMARCK ” Practice Location

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