Provider Demographics
NPI:1790197671
Name:SANFORD BISMARCK
Entity Type:Organization
Organization Name:SANFORD BISMARCK
Other - Org Name:MOBILE MED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENTERPRISE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-323-5733
Mailing Address - Street 1:2603 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-5107
Mailing Address - Country:US
Mailing Address - Phone:701-323-5222
Mailing Address - Fax:701-323-5867
Practice Address - Street 1:2603 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-5107
Practice Address - Country:US
Practice Address - Phone:701-323-5222
Practice Address - Fax:701-323-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine