SANFORD CLINIC NORTH (NPI# 1164652640) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164652640 |
| Entity Type | Organization |
| Organization Name | SANFORD CLINIC NORTH |
| Other Organization Name | SANFORD HISTOCOMPATIBILITY LAB |
| Practice Address |
737 Broadway Fargo ND 58122-0045 |
| Mailing Address |
720 4th St N Po Box 2010 Fargo ND 58122-0605 |
| Practice Telephone | 7012342000 |
| Mailing Telephone | 7012342000 |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2019-11-20 |
| 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 | 291U00000X | Clinical Medical Laboratory | Laboratories |
| Other Name | Type Code |
|---|---|
| Sanford Histocompatibility Lab | 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 |
737 BROADWAY |
| City | FARGO |
| State | ND |
| Zip Code | 58122-0045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437103959 | Robin J Sickels | Dietitian, Registered | 737 Broadway, Fargo, ND 58122-0001 | 2006-05-20 |
| 1679883680 | Summer Schauer | Nurse Anesthetist, Certified Registered | 737 Broadway, Fargo, ND 58122-0001 | 2010-10-13 |
| 1588974596 | Melissa Vanmatre | Nurse Anesthetist, Certified Registered | 737 Broadway, Fargo, ND 58122-0001 | 2010-10-13 |
| 1710138375 | Kent C Moser | Nurse Anesthetist, Certified Registered | 737 Broadway, Fargo, ND 58122-0001 | 2008-10-01 |
| 1023268711 | Katie C Busker | Nurse Anesthetist, Certified Registered | 737 Broadway, Fargo, ND 58122 | 2008-09-30 |
| 1770731473 | Andrea B Peterson | Nurse Practitioner | 737 Broadway, Fargo, ND 58122-0001 | 2008-09-05 |
| 1801091384 | Vijay Korimilli | Internal Medicine | 737 Broadway, Fargo, ND 58122-0001 | 2007-06-15 |
| 1437362571 | Heidi J Lako-adamson | Emergency Medicine | 737 Broadway, Fargo, ND 58122-0001 | 2007-05-07 |
| 1164567970 | Kristen M Liebl | Dietary Manager | 737 Broadway, Fargo, ND 58122-0001 | 2007-02-20 |
| 1063565802 | Bruce I Errett | Anesthesiology | 737 Broadway, Fargo, ND 58122-0001 | 2007-01-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184142747 | Kayla Estepp | Internal Medicine | 737 Broadway North, Fargo, ND 58122 | 2017-09-05 |
| 1376091793 | Paul Mckay | Physical Therapist | 801 Broadway N., Fargo, ND 58122 | 2016-09-14 |
| 1801290150 | Mark Noah | Physical Therapist | 1720 South University, Fargo, ND 58122 | 2014-10-15 |
| 1245633486 | Diana Palm | Physical Therapist | 1720 University Drive South, Fargo, ND 58122 | 2014-10-02 |
| 1447696406 | Mohamad Imam | Internal Medicine | 801 Broadway North, Fargo, ND 58122 | 2013-05-17 |
| 1457615155 | Chantee Seung Gruenhagen | Nurse Practitioner | 737 North Broadway, Sanford Urology Clinic, Fargo, ND 58122 | 2012-06-27 |
| 1457594079 | Manisha Balhara | Specialist | 2400 32nd Avenue S, Fargo, ND 58122 | 2009-04-13 |
| 1578536728 | Shelby A Terstriep | Internal Medicine | 820 4 Street North, Fargo, NC 58122 | 2006-02-08 |
| 1295229946 | Christopher Hinh | Student in an Organized Health Care Education/Training Program | 801 Broadway North, Fargo, ND 58122 | 2018-06-17 |
| 1558854539 | Suchita Kotnala | Family Medicine | 737 Broadway North, Fargo, ND 58122 | 2018-06-13 |
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| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275898678 | Pracs Institute Management, LLC | Clinical Medical Laboratory | 4801 Amber Valley Pkwy S, Fargo, ND 58104-8623 | 2012-07-11 |
| 1609144294 | Sanford Clinic North | Clinical Medical Laboratory | 2601 Broadway N, Fargo, ND 58102-6704 | 2011-12-09 |
| 1174680052 | Sanford Clinic North | Clinical Medical Laboratory | 1720 University Dr S, Fargo, ND 58103-4940 | 2007-01-02 |
| 1225194574 | Sanford Clinic North | Clinical Medical Laboratory | 737 Broadway, Fargo, ND 58122-0040 | 2006-12-29 |
| 1740220391 | Dakota Clinic, Ltd. | Clinical Medical Laboratory | 1702 University Dr S, Fargo, ND 58103-4940 | 2006-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588004410 | Medscan Laboratory Inc | Clinical Medical Laboratory | 1502 13th Ave, Suite 201, Williston, ND 58801-3825 | 2013-06-25 |
| 1346307774 | Pathology & Imaging Consultants, PC | Clinical Medical Laboratory | 1410 3rd Ave Sw, Minot, ND 58701-3658 | 2007-01-03 |
| 1356449136 | Northwood Deaconess Health Center | Clinical Medical Laboratory | 4 North Park St, Northwood, ND 58267-0190 | 2006-09-20 |
| 1356875553 | Vitas Laboratory LLC | Clinical Medical Laboratory | 1191 S Columbia Rd, Grand Forks, ND 58201-4033 | 2017-04-13 |
| 1700130515 | Sanford West | Clinical Medical Laboratory | 300 N 7th St, Bismarck, ND 58501-4439 | 2012-10-31 |
| 1316273998 | Trinity Health | Clinical Medical Laboratory | 1321 W Dakota Pkwy, Williston, ND 58801-3807 | 2009-11-02 |
| 1902949845 | Trinity Health | Clinical Medical Laboratory | 1102 Main St, Williston, ND 58801-4233 | 2007-02-14 |
| 1154485944 | Sanford Bismarck | Clinical Medical Laboratory | 222 N 7th St, Bismarck, ND 58501-4436 | 2006-12-19 |
| 1780788380 | Trenton Indian Service Area | Clinical Medical Laboratory | 331 4th Ave E, Trenton, ND 58853-9998 | 2006-09-12 |
| 1104862606 | Aurora Medical Park Laboratory LLC | Clinical Medical Laboratory | 1451 44th Ave S, Unit D, Suite H, Grand Forks, ND 58201-3434 | 2006-06-22 |
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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.