SANFORD MEDICAL CENTER FARGO NPI 1831131234

NPI Information

NPI: 1831131234
Provider Name: SANFORD MEDICAL CENTER FARGO

Doing Business As: SANFORD HEALTH MAHNOMEN CLINIC

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
410 4TH ST NW
MAHNOMEN, MN
ZIP 56557
Phone: (218) 935-2514
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SANFORD MEDICAL CENTER FARGO is a rural health clinic center in Mahnomen, MN. SANFORD MEDICAL CENTER FARGO NPI is 1831131234. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Sanford Health Mahnomen Clinic.

The provider's business location address is:

410 4TH ST NW
MAHNOMEN, MN
ZIP 56557-208
Phone: (218) 935-2514
Fax: (218) 935-2720

The provider's authorized official is Tony Lee Morrison .
The authorized official title is Vice President, Revenue Cycle and has the following contact phone number (605) 328-8380.

The CLIA number assigned to this NPI record is 24D0726258 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/11/2006 and was last updated on 11/29/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207Q00000X	Family Medicine		No
2	207R00000X	Internal Medicine		No
3	207V00000X	Obstetrics & Gynecology		No
4	261QR1300X	Clinic/Center	Rural Health	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	954222100	MEDICAID	MINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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