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NPI Code Detail

MEDICARE: SANFORD MEDICAL CENTER FARGO

MEDICARE: SANFORD MEDICAL CENTER FARGO
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
13336C0003XCommunity/Retail Pharmacy263507MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12124937OTHERPK

General Provider Information

NPI Number : 1568789121
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANFORD MEDICAL CENTER FARGO
Provider Business Mailing Address
First Line : 1245 WASHINGTON AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-3905
Country : US
Telephone Number : 701-234-2121
Fax Number :
Provider Business Practice Location Address
First Line : 1245 WASHINGTON AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-3905
Country : US
Telephone Number : 218-846-2276
Fax Number : 701-234-7476
Authorized Official
Title or Position : VICE PRESIDENT, REVENUE CYCLE
Name : TONY LEE MORRISON
Credential :
Telephone Number : 605-328-8380
Provider Enumeration Date : 04/22/2010
Last Update Date : 12/12/2023

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Directions to “SANFORD MEDICAL CENTER FARGO ” Practice Location

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