SANFORD CLINIC NORTH (NPI# 1124218961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124218961 |
| Entity Type | Organization |
| Organization Name | SANFORD CLINIC NORTH |
| Other Organization Name | SANFORD PROFESSIONAL BUILDING |
| Practice Address |
100 4th St S Fargo ND 58103-1929 |
| Practice Telephone | 7012343100 |
| Practice Fax Number | 7012343120 |
| Mailing Telephone | 7012343100 |
| Mailing Fax Number | 7012343120 |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2019-11-19 |
| Authorized Official Name | MARTHA K LECLERC (VP) |
| Authorized Official Telephone | 7012346248 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Sanford Professional Building | 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 |
| 1124122783 | Sanford Clinic North | Durable Medical Equipment & Medical Supplies | 4000 28th Ave S, Moorhead, MN 56560 | 2006-09-12 |
| 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 |
| 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 |
100 4TH ST S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-1929 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720078405 | Mark Allan Schaffer | Dentist | 100 4th St S, Suite 312, Fargo, ND 58103-1929 | 2005-10-25 |
| 1386280261 | Canopy Medical Clinic, Pllc | Nurse Practitioner | 100 4th St S, Fargo, ND 58103-1929 | 2019-11-26 |
| 1437715166 | Diana Rose Slivensky | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2019-05-17 |
| 1861945784 | Resolve Behavioral Health, LLC | Community/Behavioral Health | 100 4th St S, Fargo, ND 58103-1929 | 2016-07-27 |
| 1578927315 | Jason Cossette | Pharmacist | 100 4th St S, Fargo, ND 58103-1929 | 2016-04-07 |
| 1437521366 | Nicole A Kiewel | Clinical Neuropsychologist | 100 4th St S, Fargo, ND 58103-1929 | 2015-10-30 |
| 1821472143 | Angela M Lee | Nurse Practitioner | 100 4th St S, Fargo, ND 58103-1929 | 2015-07-16 |
| 1104231992 | Mustafa Abdulhusein | Psychiatry & Neurology | 100 4th St S, Fargo, ND 58103 | 2014-06-30 |
| 1609205988 | Robyn Maley | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2013-11-06 |
| 1699102897 | Lindsey Marie Sloan Peterson | Nurse Practitioner | 100 4th St S, Fargo, ND 58103-1929 | 2013-10-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093757791 | Carita R Shawchuck | Psychologist | 1121 Westrac Dr S, Suite 204, Fargo, ND 58103-8716 | 2006-06-10 |
| 1437715166 | Diana Rose Slivensky | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2019-05-17 |
| 1609205988 | Robyn Maley | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2013-11-06 |
| 1649604869 | Daniel Barrett Landauer | Psychologist | 1711 University Dr S, Fargo, ND 58103-4939 | 2013-08-23 |
| 1013269257 | Carita R Shawchuck, Phd, PC | Psychologist | 1121 Westrac Dr S Ste 204, Fargo, ND 58103-2385 | 2012-10-12 |
| 1962782268 | Sanford Medical Center Fargo | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2011-08-18 |
| 1871650267 | Carita R Shawchuck Phd PC | Psychologist | 1351 Page Dr S, Suite 105, Fargo, ND 58103-3502 | 2007-01-03 |
| 1497776736 | Rebecca Suzanne Preussler | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2006-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1912243148 | Beacon Behavioral Health Services | Psychologist | 102 W Beaton Dr, Suite 103, West Fargo, ND 58078-2652 | 2012-12-16 |
| 1972756583 | Shyla L Muse | Psychologist | 3535 S 31st St Ste 201, Grand Forks, ND 58201 | 2008-10-28 |
| 1770549032 | Catherine Yeager | Psychologist | 3535 S 31st St Ste 201, Grand Forks, ND 58201-3593 | 2006-04-25 |
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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.