Provider Demographics
NPI:1518061803
Name:SANFORD HEALTH NETWORK NORTH
Entity Type:Organization
Organization Name:SANFORD HEALTH NETWORK NORTH
Other - Org Name:SANFORD MEDICAL CENTER MAYVILLE
Other - Org Type:Former Legal Business Name
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 1:42 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:ND
Practice Address - Zip Code:58257-1506
Practice Address - Country:US
Practice Address - Phone:701-788-3800
Practice Address - Fax:701-788-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5034282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
0953HUNOtherMN BLUE CROSS BLUE SHIELD
5021423OtherMEDICA
ND000273OtherBLUE CROSS OF ND
MN940850900Medicaid
ND001906Medicaid
ND002683OtherND BLUE CROSS BLUE SHIELD
ND003200008OtherTRICARE
01010308OtherPREFERRED ONE
ND001038Medicaid
ND351309Medicare Oscar/Certification
ND351309Medicare PIN
ND35Z309Medicare Oscar/Certification
0953HUNOtherMN BLUE CROSS BLUE SHIELD
ND0673900001Medicare NSC