SANFORD MEDICAL CENTER FARGO (NPI# 1114207412) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114207412 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD NORTH FARGO CLINIC |
| Practice Address |
2601 Broadway N Fargo ND 58102-6704 |
| Practice Telephone | 7012342900 |
| Mailing Telephone | 7012342900 |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | MARTHA LECLERC (VICE PRESIDENT) |
| Authorized Official Telephone | 7012346248 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Sanford North Fargo Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245519081 | Sanford Medical Center Fargo | General Acute Care Hospital | 2990 Seter Parkway, Fargo, ND 58104-8750 | 2011-08-10 |
| 1558458844 | Sanford Medical Center Fargo | Pharmacy | 1720 S University Drive, Fargo, ND 58103-4940 | 2006-10-06 |
| 1578508198 | Sanford Medical Center Fargo | Clinic/Center | 1234 Washington Ave Ste B, Detroit Lakes, MN 56501-3906 | 2006-06-18 |
| 1225635634 | Sanford Medical Center Fargo | Pharmacy | 1720 University Dr S, Fargo, ND 58103-4940 | 2020-10-08 |
| 1174120281 | Sanford Medical Center Fargo | Pharmacy | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-10-02 |
| 1013559905 | Sanford Medical Center Fargo | Hospice Care, Community Based | 801 Broadway N, Fargo, ND 58102-3641 | 2019-10-11 |
| 1366092801 | Sanford Medical Center Fargo | Hospice Care, Community Based | 820 4th St N, Fargo, ND 58102-4539 | 2019-09-17 |
| 1861927709 | Sanford Medical Center Fargo | Pharmacy | 5225 23rd Ave S, Fargo, ND 58104 | 2017-04-28 |
| 1801151394 | Sanford Medical Center Fargo | Clinic/Center | 2400 32nd Ave S, Fargo, ND 58103-5800 | 2012-07-10 |
| 1366717118 | Sanford Medical Center Fargo | Clinic/Center | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2012-03-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SANFORD MEDICAL CENTER FARGO | 720 N 4th St, Fargo, ND 58122-4520 |
| Street Address |
2601 BROADWAY N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-6704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194751594 | Sanford Clinic North | Family Medicine | 2601 Broadway N, Fargo, ND 58102-6704 | 2006-06-25 |
| 1457844581 | Kristina Jean Gresh | Nurse Practitioner | 2601 Broadway N, Fargo, ND 58102-1406 | 2018-06-13 |
| 1629571443 | Kayla Marie Weigel | Registered Nurse | 2601 Broadway N, Fargo, ND 58102-1406 | 2018-03-18 |
| 1427492677 | Jessie Lindemann | Family Medicine | 2601 Broadway N, Fargo, ND 58102-1406 | 2013-04-18 |
| 1609144294 | Sanford Clinic North | Clinical Medical Laboratory | 2601 Broadway N, Fargo, ND 58102-6704 | 2011-12-09 |
| 1275763955 | Autumn Branca | Physician Assistant | 2601 Broadway N, Fargo, ND 58102-6704 | 2009-07-16 |
| 1326294513 | Tracy Kirchner | Physical Therapist | 2601 Broadway N, Fargo, ND 58102-1406 | 2008-08-07 |
| 1235151721 | Jennifer L Kringlie | Nurse Practitioner | 2601 Broadway N, Fargo, ND 58102-6704 | 2006-07-24 |
| 1093733693 | Terry A Peterson | Physician Assistant | 2601 Broadway N, Fargo, ND 58102-6704 | 2006-07-18 |
| 1093732760 | Shao Chyi Lee | Family Medicine | 2601 Broadway N, Fargo, ND 58102-6704 | 2006-07-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679068035 | Rory Ratzlaff | Family Medicine | Sanford Health 737 Broadway N, Fargo, ND 58122-0001 | 2018-06-28 |
| 1710472725 | Shabnum Gupta | Family Medicine | Sanford Health 801 Broadway North, Fargo, ND 58122-0170 | 2018-06-22 |
| 1538661384 | Community Uplift Program | Family Medicine | 417 Main Ave Ste 401, Fargo, ND 58103-1956 | 2018-03-07 |
| 1841576279 | Michelle Vonrueden | Family Medicine | 1018 18th St S, Fargo, ND 58103-2926 | 2011-10-31 |
| 1801174768 | Vidya Vijayaraghavan | Family Medicine | 4689 38th Ave S, Fargo, ND 58104-8506 | 2011-07-26 |
| 1275762924 | Sreejith Gopi | Family Medicine | 4110 51st Avenue South, Fargo, ND 58104 | 2009-07-02 |
| 1356537781 | Terry L Wolff | Family Medicine | 2700 12th Ave Sw, Suite D, Fargo, ND 58103 | 2007-09-19 |
| 1144436338 | Daniel Wilfred Herold | Family Medicine | 225 4th Ave N, Fargo Meps, Fargo, ND 58102-4841 | 2007-05-15 |
| 1679619860 | Carl John Fedyszyn, M.d.,p.c. | Family Medicine | 4550 47th St S Apt 102, Fargo, ND 58104-4360 | 2007-01-29 |
| 1417040189 | Michelle M Radke | Family Medicine | 1711 Gold Drive South Suite 160, Fargo, ND 58103 | 2006-10-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.