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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MN | 1124122783 | 05 | |
MEDICA | 82-00338 | 01 | |
ND | 21559 | 05 | |
NCPDP | 24-17081 | 01 |
Other Name | Type Code |
---|---|
Sanford Pharmacy Moorhead | Doing Business As Name - Organization |
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 |
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 |
Street Address |
4000 28TH AVE S |
City | MOORHEAD |
State | MN |
Zip Code | 56560 |
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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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 |
Find all providers in zip 56560 |
Taxonomy Code | 3336C0002X |
Grouping | Suppliers |
Classification | Pharmacy |
Specialization | Clinic Pharmacy |
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] |
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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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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.