Sanford Medical Center Fargo
Organization Active NPI Clinic Pharmacy · Moorhead, MN
NPI 1124122783 · NPPES record last updated Dec 12, 2023
Key facts
- NPI
- 1124122783
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic Pharmacy 3336C0002X
- License
- 2602723 (MN)
- Legal business name
- SANFORD MEDICAL CENTER FARGO
- Practice address
- 4000 28TH Ave S
Moorhead, MN 56560 - Phone
- (701) 234-3250
- NPI assigned
- Sep 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Tony Lee Morrison
- Title
- Vice President, Revenue Cycle
- Phone
- (605) 328-8380
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 13
Member of 1
Practitioners 9
-
Lauren Anne Bakke, PA-C
-
Susan K Cariveau, NP
-
Jon D Larson, MD
-
Tamera Ostenaa, APRN, CNP
-
Rebecca Schulz, FNP
-
Nancy J Stock, NP
-
Abby Lynn Wing, APRN
-
Mechelle A Zima, FNP-C
-
Jason J Hellman, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160511000104 | MN | Part B Supplier - Mass Immunization (Roster Biller Only) | 4284546151 |
4 other NPIs on this enrollment Practice locations: Detroit Lakes, MN; Moorhead, MN; Thief River Falls, MN |
| O20240507002390 | MN | DME Supplier - Pharmacy | 8426967803 | Practice locations: Moorhead, MN |
National Provider Directory
- Tax ID family
- Bemidji Same Day Surgery
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 2602723 | MN | |
| Clinic Pharmacy | 3336C0002X | 2602723 | MN | Yes |
Addresses
Primary practice location
4000 28TH Ave S
Moorhead, MN 56560
Mailing address
4000 28TH Ave S
Moorhead, MN 56560-7926
Phone (701) 234-2121
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124122783 | Medicaid | MN | |
| 24-17081 | Other | NCPDP | |
| 21559 | Medicaid | ND | |
| 82-00338 | Other | MEDICA |
Other names
- Sanford Pharmacy Moorhead
Other providers in Moorhead, MN
- Erin Saladin
- Samawade Home Health Care LLC
- Michael L Sand
- Sanford Clinic North
- Sanford Clinic North
- Sanford Medical Center Fargo
- Sara Stallman PLLC
- Cameron Curtis Satoris
- Kathleen Sayler
- Andrew William Schaaf
All providers in Moorhead, MN · Clinic Pharmacy in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.