Provider Demographics
NPI: | 1942241351 |
---|---|
Name: | SANFORD CLINIC NORTH |
Entity Type: | Organization |
Organization Name: | SANFORD CLINIC NORTH |
Other - Org Name: | SANFORD HEALTH GRAND FORKS CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VICE PRESIDENT |
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: | |
Practice Address - Street 1: | 801 BROADWAY N |
Practice Address - Street 2: | |
Practice Address - City: | FARGO |
Practice Address - State: | ND |
Practice Address - Zip Code: | 58102-3641 |
Practice Address - Country: | US |
Practice Address - Phone: | 701-234-2000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-09 |
Last Update Date: | 2023-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | Group - Multi-Specialty | |
No | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 207ZP0101X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 291U00000X | Laboratories | Clinical Medical Laboratory | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
ND | 192972600 | Other | FEDERAL WORKERS COMP |
ND | CD8870 | Other | RR MEDICARE |
MN | CD8868 | Other | RR MEDICARE |
ND | 192974000 | Other | FEDERAL WORKERS COMP(MC) |
ND | N70848 | Medicare PIN | |
ND | 192974000 | Other | FEDERAL WORKERS COMP(MC) |
ND | N70401 | Medicare PIN | |
CD8870 | Medicare PIN | ||
ND | N70751 | Medicare PIN | |
CD8868 | Medicare PIN | ||
ND | CD8870 | Other | RR MEDICARE |
ND | N70339 | Medicare PIN | |
ND | N70359 | Medicare PIN | |
ND | N70846 | Medicare PIN | |
ND | N70918 | Medicare PIN | |
ND | N71155 | Medicare PIN | |
MN | CD8868 | Other | RR MEDICARE |
ND | N71069 | Medicare PIN | |
ND | 192972600 | Other | FEDERAL WORKERS COMP |
ND | N70164 | Medicare PIN | |
ND | N70204 | Medicare PIN | |
ND | N71157 | Medicare PIN | |
ND | N70334 | Medicare PIN | |
ND | N70332 | Medicare PIN |