Provider Demographics
NPI:1164439196
Name:SANFORD MEDICAL CENTER FARGO
Entity Type:Organization
Organization Name:SANFORD MEDICAL CENTER FARGO
Other - Org Name:SANFORD HEALTH LAMOURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-328-8380
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58107-2168
Mailing Address - Country:US
Mailing Address - Phone:701-234-2119
Mailing Address - Fax:
Practice Address - Street 1:100 1ST AVENUE SW
Practice Address - Street 2:SUITE 2
Practice Address - City:LAMOURE
Practice Address - State:ND
Practice Address - Zip Code:58458-7311
Practice Address - Country:US
Practice Address - Phone:701-883-5048
Practice Address - Fax:701-883-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5132Medicaid
ND12857Medicaid
ND1328001OtherBLUE SHIELD
NDCF8850OtherRAILROAD MEDICARE
NDCF8850Medicare PIN
ND12857Medicaid
NDCF8850OtherRAILROAD MEDICARE
ND353844Medicare Oscar/Certification