Provider Demographics
NPI:1891861761
Name:SANFORD MEDICAL CENTER FARGO
Entity Type:Organization
Organization Name:SANFORD MEDICAL CENTER FARGO
Other - Org Name:SANFORD HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, 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 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-8311
Practice Address - Street 1:3223 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6297
Practice Address - Country:US
Practice Address - Phone:701-234-4900
Practice Address - Fax:701-234-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4014A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1014621OtherPREFERREDONE
ND33110Medicaid
ND59687Medicaid
5900226OtherMEDICA
7A42HEOtherMNBC
3434OtherNDBC
37866OtherHEALTHPARTNERS
3434OtherNDBC
ND59687Medicaid