SANFORD MEDICAL CENTER FARGO (NPI# 1124189741) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124189741 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD DIALYSIS RED LAKE |
| Practice Address |
24760 Hospital Dr Red Lake MN 56671 |
| Mailing Address |
Po Box 2168 Fargo ND 58107-2168 |
| Practice Telephone | 2186793117 |
| Practice Fax Number | 2186764386 |
| Mailing Telephone | 7012342119 |
| Mailing Fax Number | 7012342045 |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-07-31 |
| 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 |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 632605600 | 05 |
| Other Name | Type Code |
|---|---|
| Sanford Dialysis Red Lake | 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 |
24760 HOSPITAL DR |
| City | RED LAKE |
| State | MN |
| Zip Code | 56671 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245279835 | Rachel Koch | Nurse Practitioner | 24760 Hospital Dr, Red Lake, MN 56671-0497 | 2006-06-06 |
| 1922519263 | Sherry Daker | Pharmacist | 24760 Hospital Dr, Red Lake, MN 56671 | 2017-10-13 |
| 1558525022 | Alma Flora Tatum | Pediatrics | 24760 Hospital Dr, Red Lake, MN 56671 | 2008-07-14 |
| 1942216668 | Tiffany Hommes | Registered Nurse | 24760 Hospital Dr, Red Lake, MN 56671 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063030419 | Red Lake Homeless Shelter Inc. | Case Management | 15855 Main Ave, Red Lake, MN 56671 | 2020-07-13 |
| 1376026153 | Children's Healing Center | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 25060 Hwy 1 East, Red Lake, MN 56671 | 2018-09-08 |
| 1003332057 | Red Lake Detention Outpatient | Substance Abuse Rehabilitation Facility | 25064 Highway 1 East, Red Lake, MN 56671 | 2017-08-21 |
| 1831642214 | Jennifer Franke | Pharmacist | 24760 Hospital Rd., Red Lake, MN 56671 | 2016-08-02 |
| 1538445978 | Hoaibac Nguyen | Pharmacist | 24760 Hospital Rd, Red Lake, MN 56671 | 2011-10-31 |
| 1639466048 | Red Lake Comprehensive Health Services | Dental Hygienist | 24809 Hospital Drive, Highway 1, Redlake, MN 56671 | 2011-07-06 |
| 1821391822 | Jill Christine Andersen | Physical Therapist | Hwy 1 Hospital Dr. Box 497, Red Lake, MN 56671 | 2010-12-13 |
| 1871802934 | Elizabeth Vivian Rose | Dentist | 24760 Hospital Dr., Red Lake, MN 56671 | 2010-10-06 |
| 1225202625 | Redlake Chemical Health Program Group Home | Substance Abuse Rehabilitation Facility | 15797 Main Avenue, Redlake, MN 56671 | 2008-04-16 |
| 1104029388 | Shannon Carl Nelson | General Acute Care Hospital | Highway 1 Box 497, Red Lake, MN 56671 | 2007-06-06 |
| Find all providers in zip 56671 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770183832 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 6160 Summit Dr N Ste 150, Brooklyn Center, MN 55430-2118 | 2020-10-28 |
| 1902392111 | Chaffee Dialysis LLC | Clinic/Center | 862 Arcade St, Saint Paul, MN 55106 | 2018-07-11 |
| 1225541055 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 7433 Currell Blvd, Woodbury, MN 55125-2217 | 2017-11-15 |
| 1154856839 | Avera Marshall | Clinic/Center | 300 S Bruce St Ste D, Marshall, MN 56258-1934 | 2017-05-01 |
| 1225573777 | Atlantic Dialysis LLC | Clinic/Center | 1802 Commerce Dr, North Mankato, MN 56003-1800 | 2016-12-19 |
| 1437694981 | Atlantic Dialysis LLC | Clinic/Center | 701 N Broadway St, New Ulm, MN 56073-1201 | 2016-12-19 |
| 1467801860 | Total Renal Care, Inc. | Clinic/Center | 20184 Heritage Dr, Lakeville, MN 55044-6855 | 2016-06-07 |
| 1003292392 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 17592 Dodd Blvd, Lakeville, MN 55044-3909 | 2015-08-10 |
| 1629461470 | Babler Dialysis, LLC | Clinic/Center | 2660 S Broadway, Ste A, Rochester, MN 55904-6263 | 2015-03-17 |
| 1588067391 | Meesa Dialysis LLC | Clinic/Center | 245 Isle St W, Isle, MN 56342-4908 | 2014-10-07 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SANFORD MEDICAL CENTER FARGO.
| 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.