SANFORD MEDICAL CENTER FARGO (NPI# 1508146846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508146846 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | PERHAM HEALTH |
| Practice Address |
665 3rd St Sw Perham MN 56573-1137 |
| Practice Telephone | 2183471200 |
| Mailing Telephone | 2183471200 |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2011-11-07 |
| 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 | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Perham Health | 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 |
665 3RD ST SW |
| City | PERHAM |
| State | MN |
| Zip Code | 56573-1137 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194793562 | Richard W Masur | Emergency Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-03-10 |
| 1457631814 | Perham Hospital District | Internal Medicine | 665 3rd St Sw, Perham, MN 56573-1199 | 2011-08-17 |
| 1760786032 | Marisa Lea Zutter | Nurse Practitioner | 665 3rd St Sw, Perham, MN 56573-1137 | 2010-12-30 |
| 1528220498 | Amy Marie Vogt | Pharmacist | 665 3rd St Sw, Suite 100, Perham, MN 56573-1137 | 2008-07-01 |
| 1679730378 | Duane Wallace | Pharmacist | 665 3rd St Sw, Perham, MN 56573-1137 | 2008-05-20 |
| 1770760605 | Ronica Marie Wahl | Nurse Practitioner | 665 3rd St Sw, Perham, MN 56573-1137 | 2008-01-22 |
| 1710905351 | Stephen R Hietala | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-18 |
| 1225056955 | Jeffrey L Blickenstaff | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-18 |
| 1386661858 | Corey L Nyhus | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-17 |
| 1295766392 | Mark R Paulson | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558630012 | Perham Hospital District | Durable Medical Equipment & Medical Supplies | 1000 Coney Street West, Perham, MN 56573 | 2011-12-29 |
| 1730239385 | Dr. Kelvin K. Salathe, P.C. | Chiropractor | 101 West Coney St, Perham, MN 56573 | 2007-01-12 |
| 1124106299 | Langen Family Chiropractic, P.a. | Chiropractor | 108 Market Dr., Perham, MN 56573 | 2006-11-02 |
| 1285710335 | James Odin Langen | Chiropractor | 108 Market Drive, Perham, MN 56573 | 2006-10-31 |
| 1578572202 | Michael L Hamann | Dentist | 200 1st Ave S, Perham, MN 56573 | 2006-08-05 |
| 1033133517 | Timothy Charles Neitzke | Optometrist | 340 Fox St, Perham, MN 56573 | 2006-07-27 |
| 1023063757 | Shopko Stores Operating Co LLC | Pharmacy | 300 Jake St, Perham, MN 56573 | 2006-05-23 |
| 1164917233 | Katlin Larson | Behavior Technician | 735 3rd St Sw, Perham, MN 56573 | 2018-06-29 |
| 1104029347 | Tammy L Sturdevant | Dentist | 335 4th Ave, Perham, MN 56573 | 2007-06-06 |
| 1861610131 | Minnesota Eyecare Network Inc. | Eyewear Supplier (Equipment, not the service) | 340 Fox Street, Perham, MN 56573 | 2007-04-23 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982913505 | Illene T Reed | Family Medicine | 1000 Coney St W, Perham, MN 56573-2102 | 2006-05-05 |
| 1134656994 | Matthew David Haugen | Family Medicine | 1000 Coney St W, Perham, MN 56573-2102 | 2017-05-11 |
| 1114280831 | Kailey Witt | Family Medicine | 1000 Coney St W, Perham, MN 56573-2102 | 2012-06-18 |
| 1902033855 | Jane D Winston | Family Medicine | 1000 Coney St W, Perham, MN 56573-2102 | 2009-06-18 |
| 1154343721 | Chad G Thiel | Family Medicine | 1000 Coney St W, Perham, MN 56573-2102 | 2006-07-24 |
| 1710905351 | Stephen R Hietala | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-18 |
| 1225056955 | Jeffrey L Blickenstaff | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-18 |
| 1386661858 | Corey L Nyhus | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-17 |
| 1982637385 | Sanford Clinic North | Family Medicine | 1000 Coney St W, Perham, MN 56573-2102 | 2006-07-09 |
| 1295766392 | Mark R Paulson | Family Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-07-06 |
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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.