SANFORD CLINIC NORTH


Address: 4000 28th Ave S, Moorhead, MN 56560
Phone: 7012343250

SANFORD CLINIC NORTH (NPI# 1124122783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1124122783
Entity Type Organization
Organization Name SANFORD CLINIC NORTH
Other Organization Name SANFORD PHARMACY MOORHEAD
Practice Address 4000 28th Ave S
Moorhead
MN 56560
Mailing Address 4000 28th Ave S
Moorhead
MN 56560-7926
Practice Telephone 7012343250
Mailing Telephone 7012342121
Enumeration Date 2006-09-12
Last Update Date 2020-06-29
Authorized Official Name TONY LEE MORRISON (VICE PRESIDENT, REVENUE CYCLE)
Authorized Official Telephone 6053288380
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 332B00000X Durable Medical Equipment & Medical Supplies 2602723 MN Suppliers
Y 3336C0002X Pharmacy
Specialization: Clinic Pharmacy
2602723 MN Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
MN 1124122783 05
MEDICA 82-00338 01
ND 21559 05
NCPDP 24-17081 01

Other Provider/Organization Names

Other Name Type Code
Sanford Pharmacy Moorhead Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1477042372 Sanford Clinic North Pharmacy 1611 Anne St Nw Ste 1, Bemidji, MN 56601-5114 2018-05-07
1386099026 Sanford Clinic North Clinic/Center 625 Demers Ave, East Grand Forks, MN 56721-1833 2016-05-02
1922361716 Sanford Clinic North Internal Medicine 2960 Seter Pkwy, Fargo, ND 58104-8692 2012-06-18
1922303213 Sanford Clinic North Clinic/Center 1245 Washington Avenue, Detroit Lakes, MN 56501-3905 2011-01-18
1437355393 Sanford Clinic North Family Medicine 929 Central Avenue, East Grand Forks, MN 56721 2007-06-26
1679677124 Sanford Clinic North Durable Medical Equipment & Medical Supplies 1233 34th St Nw Ste C, Bemidji, MN 56601 2006-09-12
1073520003 Sanford Clinic North Clinic/Center 336 Main Street, Forman, ND 58032-0184 2006-08-02
1164439196 Sanford Clinic North Clinic/Center 100 1st Avenue Sw, Suite 2, Lamoure, ND 58458-7311 2006-08-02
1255348280 Sanford Clinic North Clinic/Center 21 Wiley Avenue South, Lidgerwood, ND 58053-4001 2006-08-02
1780690305 Sanford Clinic North Clinic/Center 69 Highway 13 W, Gwinner, ND 58040-4127 2006-08-01

Other Data Sources

Entity Type Entity Name Entity Address
Iowa Business Entities SANFORD CLINIC NORTH 801 Broadway North, Fargo, ND 58122
System for Award Management (SAM) Entities SANFORD CLINIC NORTH FARGO 801 Broadway N, Fargo, ND 58102-3641

Office Location

Street Address 4000 28TH AVE S
City MOORHEAD
State MN
Zip Code 56560

Providers in the same location

NPI Name Taxonomy Address Enumeration
1447772470 Dustin Joel Czapiewski Nurse Practitioner 4000 28th Ave S, Moorhead, MN 56560-7926 2017-07-12
1568996700 Alyson Dahl Physician Assistant 4000 28th Ave S, Moorhead, MN 56560-7926 2017-04-14
1568836781 Courtney Jo Burgad Social Worker 4000 28th Ave S, Moorhead, MN 56560-7926 2015-11-27
1114314093 Amy Joy Bro Nurse Practitioner 4000 28th Ave S, Moorhead, MN 56560-7926 2015-04-19
1073910253 Laura Fugleberg Physician Assistant 4000 28th Ave S, Moorhead, MN 56560-7926 2014-12-03
1205240900 Amanda Oney Nurse Practitioner 4000 28th Ave S, Moorhead, MN 56560 2014-06-20
1760801187 Natalie Frances Dvorak Pediatrics 4000 28th Ave S, Moorhead, MN 56560-7926 2014-04-14
1093134462 Kyra Decker Nurse Practitioner 4000 28th Ave S, Moorhead, MN 56560 2014-04-14
1083992002 Samantha J Perleberg Pediatrics 4000 28th Ave S, Moorhead, MN 56560 2011-07-25
1619288602 Donald R. Gullicks Obstetrics & Gynecology 4000 28th Ave S, Moorhead, MN 56560-7926 2010-06-24
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1386298859 Anna Mckay Fox Pharmacist 4000 28th Avenue S, Moorhead, MN 56560 2019-08-01
1972019727 Michael Wayne Hilliard Specialist/Technologist 649 17th St S, Moorhead, MN 56560 2017-12-15
1508217183 Kristen Johnson Nurse Practitioner 801 Belsly Boulevard, Moorhead, MN 56560 2016-06-25
1861877052 Midwest Mental Health Clinic Nurse Practitioner 819 30th Ave S Office 206 Suite B, Moorhead, MN 56560 2015-07-29
1083037709 Drake Counseling Services, Inc. Clinic/Center 715 11th Street North, Suite 204, Moorhead, MN 56560 2014-01-31
1710310917 Lamar Terrell Hill Social Worker 420 Center Ave Ste 102, Moorhead, MN 56560 2013-08-12
1982956140 Lilac Homes Corporation Assisted Living Facility 2615 Parkview Dr, Moorhead, MN 56560 2012-10-11
1487918462 Paige Joy Hanson Massage Therapist 805 14th St. So., Msum Wellness Center, Moorhead, MN 56560 2012-06-25
1972809408 Cslm, LLC Assisted Living Facility 2401 South 11th Street, Moorhead, MN 56560 2011-02-01
1972814846 Paul Michael Fluto Pharmacist 3000 Hwy 10 East, Mooehead, MN 56560 2010-06-25
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Taxonomy Information

Taxonomy Code 3336C0002X
Grouping Suppliers
Classification Pharmacy
Specialization Clinic Pharmacy

Taxonomy Definition

A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1083138317 Fairview Pharmacy Services LLC Pharmacy 17 Exchange St W Ste 150, Saint Paul, MN 55102-1045 2017-07-28
1760792691 Goodrich Pharmacy Fridley Pharmacy 480 Osborne Rd Suite 180, Fridley, MN 55432 2010-10-13
1770719585 Fairview Pharmacy Services LLC Pharmacy 14712 Victor Hugo Blvd N Ste 10, Hugo, MN 55038-6324 2009-06-08
1548400849 Moka Pharmacy Inc Pharmacy 1515 E Franklin Ave, Minneapolis, MN 55404-2137 2009-02-26
1902012107 Metro Treatment of Minnesota, Lp Pharmacy 14 E Central Entrance, Suite B, Duluth, MN 55811-5508 2007-05-15
1790909083 Aitkin Community Hospital Inc. Pharmacy 27278 State Hwy 18, Garrison, MN 56450 2007-04-11
1437203882 Shakopee Mdewakanton Sioux Comm Phcy Pharmacy 15045 Mystic Lake Dr Nw, Prior Lake, MN 55372-9011 2007-01-23
1407931553 Waconia Pharmacy Pharmacy 430 Highway 5 West, Waconia, MN 55387-1795 2006-10-26
1548365406 Mayo Foundation for Medical Education & Research Pharmacy 201 Center St W, Ste Lo92, Rochester, MN 55902-3003 2006-09-14
1407951353 Mayo Foundation for Medical Education & Research Pharmacy 221 4th Ave Sw Ste 1116, Rochester, MN 55902-3110 2006-09-14
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Competitor

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City MOORHEAD
Zip Code 56560

Improve Information

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Dataset Information

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.

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