SANFORD CLINIC NORTH (NPI# 1235173519) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235173519 |
| Entity Type | Organization |
| Organization Name | SANFORD CLINIC NORTH |
| Other Organization Name | SANFORD PHARMACY BROADWAY |
| Practice Address |
737 Broadway Fargo ND 58102-4421 |
| Mailing Address |
737 Broadway N Fargo ND 58102-4421 |
| Practice Telephone | 7012342416 |
| Practice Fax Number | 7012342433 |
| Mailing Telephone | 7012342416 |
| Mailing Fax Number | 7012342433 |
| Enumeration Date | 2006-06-16 |
| 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 | 309 | ND | Suppliers |
| N | 3336H0001X |
Pharmacy Specialization: Home Infusion Therapy Pharmacy |
309 | ND | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
309 | ND | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 1235173519 | 05 | |
| NCPDP | 35-00712 | 01 | |
| ND | 21587 | 05 | |
| SD | 1235173519 | 05 |
| Other Name | Type Code |
|---|---|
| Sanford Pharmacy Broadway | Doing Business As Name - Organization |
| Sanford Pharmacy Roger Maris | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 820 4th St N, Fargo, ND 581024539 | 7012347554 | 7012347476 |
| 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 | 58102-4421 |
| 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 |
| 1164652640 | Sanford Clinic North | Clinical Medical Laboratory | 737 Broadway, Fargo, ND 58122-0045 | 2009-07-20 |
| 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 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912416876 | Lifescript Pharmacy Pllc | Pharmacy | 5670 38th Ave S Unit A, Fargo, ND 58104-9051 | 2017-09-23 |
| 1962706036 | Inhealth Specialty Pharmacy, Inc. | Pharmacy | 2345 25th St S Ste C, Fargo, ND 58103-6173 | 2011-01-05 |
| 1982826756 | Integrated Health Marketing LLC | Pharmacy | 5675 26th Ave S Ste 136a, Fargo, ND 58104-8975 | 2007-05-02 |
| 1891855326 | Sanger Inc | Pharmacy | 4101 13th Ave S, Fargo, ND 58103-3342 | 2006-12-12 |
| 1457419962 | Johnson Drug Co | Pharmacy | 2522 N Broadway, Fargo, ND 58102 | 2006-12-05 |
| 1649211517 | American Drug Stores Delaware LLC | Pharmacy | 1321 19th Ave N, Fargo, ND 58102-1821 | 2006-06-09 |
| 1821039793 | American Drug Stores Delaware LLC | Pharmacy | 2425 13th Ave S, Fargo, ND 58103-3749 | 2006-06-09 |
| 1396184750 | Md Pharmacy LLC | Pharmacy | 4101 13th Ave S, Suite S, Fargo, ND 58103-3342 | 2013-06-19 |
| 1124317490 | Thrifty Drug Stores Inc | Pharmacy | 706 38th St N, Unit A, Fargo, ND 58102-2953 | 2011-04-07 |
| 1609955996 | Thrifty Drug Stores Inc | Pharmacy | 706 38th St N, Fargo, ND 58102-2953 | 2006-11-06 |
| Find all providers in FARGO | ||||
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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.