SANFORD MEDICAL CENTER FARGO NPI 1578508198

NPI Information

NPI: 1578508198
Provider Name: SANFORD MEDICAL CENTER FARGO
Classification: Clinic/Center - 261QE0700X
Specialization: End-Stage Renal Disease (ESRD) Treatment
Entity Type: Organization
Doing Business As: SANFORD DIALYSIS DETROIT LAKES
CLIA Number: 24D1057892
Address: 1234 WASHINGTON AVE STE B
DETROIT LAKES, MN
ZIP 56501
Phone: (218) 846-2200

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NPI Details

SANFORD MEDICAL CENTER FARGO is an end-stage renal disease (esrd) treatment clinic center in Detroit Lakes, MN. SANFORD MEDICAL CENTER FARGO NPI is 1578508198. The provider is registered as an organization entity type.
The provider Is Doing Business As Sanford Dialysis Detroit Lakes.

The provider's business location address is:

1234 WASHINGTON AVE STE B
DETROIT LAKES, MN
ZIP 56501-906
Phone: (218) 846-2200
Fax: (218) 846-2201

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 24D1057892 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/18/2006 and was last updated on 7/2/2020.

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	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			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	012096	OTHER		NDBC
2	735547500	MEDICAID	MINNESOTA
3	1C18HME	OTHER		MNBC

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: 3/30/2025

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