SANFORD MEDICAL CENTER FARGO (NPI# 1609156934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609156934 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD MOORHEAD CLINIC |
| Practice Address |
1301 8th St S Moorhead MN 56560-3604 |
| Practice Telephone | 7012343200 |
| Mailing Telephone | 7012343200 |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | MARTHA LECLERC (VICE PRESIDENT) |
| Authorized Official Telephone | 7012346248 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Sanford Moorhead Clinic | 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 |
1301 8TH ST S |
| City | MOORHEAD |
| State | MN |
| Zip Code | 56560-3604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609855873 | Amie C Haugo | Family Medicine | 1301 8th St S, Moorhead, MN 56560-3604 | 2006-01-16 |
| 1326655689 | Samir Golos | Nurse Practitioner | 1301 8th St S, Moorhead, MN 56560-3604 | 2020-09-30 |
| 1497390298 | Keith Francis Donohue | Psychologist | 1301 8th St S, Moorhead, MN 56560-3604 | 2019-11-15 |
| 1437662640 | Caitlin Pollestad | Psychologist | 1301 8th St S, Moorhead, MN 56560-3604 | 2017-11-09 |
| 1336508274 | Amanda Storey | Psychologist | 1301 8th St S, Moorhead, MN 56560-3604 | 2016-02-21 |
| 1285005991 | Brianna J Crawford | Psychologist | 1301 8th St S, Moorhead, MN 56560-3604 | 2015-10-08 |
| 1376925958 | Yu-ting Wung | Psychiatry & Neurology | 1301 8th St S, Moorhead, MN 56560-3604 | 2015-06-19 |
| 1588044432 | Alicia Lynn Elliott | Psychiatry & Neurology | 1301 8th St S, Moorhead, MN 56560-3604 | 2015-06-05 |
| 1093005639 | Steven John Meek | Psychiatry & Neurology | 1301 8th St S, Moorhead, MN 56560-3604 | 2011-04-16 |
| 1942599048 | Jonathan Charles Olivas | Psychiatry & Neurology | 1301 8th St S, Moorhead, MN 56560-3604 | 2011-03-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386298859 | Anna Mckay Fox | Pharmacist | 4000 28th Avenue S, Moorhead, MN 56560 | 2019-08-01 |
| 1972019727 | Michael Wayne Hilliard | Specialist/Technologist | 649 17th St S, Moorhead, MN 56560 | 2017-12-15 |
| 1508217183 | Kristen Johnson | Nurse Practitioner | 801 Belsly Boulevard, Moorhead, MN 56560 | 2016-06-25 |
| 1861877052 | Midwest Mental Health Clinic | Nurse Practitioner | 819 30th Ave S Office 206 Suite B, Moorhead, MN 56560 | 2015-07-29 |
| 1083037709 | Drake Counseling Services, Inc. | Clinic/Center | 715 11th Street North, Suite 204, Moorhead, MN 56560 | 2014-01-31 |
| 1710310917 | Lamar Terrell Hill | Social Worker | 420 Center Ave Ste 102, Moorhead, MN 56560 | 2013-08-12 |
| 1982956140 | Lilac Homes Corporation | Assisted Living Facility | 2615 Parkview Dr, Moorhead, MN 56560 | 2012-10-11 |
| 1487918462 | Paige Joy Hanson | Massage Therapist | 805 14th St. So., Msum Wellness Center, Moorhead, MN 56560 | 2012-06-25 |
| 1972809408 | Cslm, LLC | Assisted Living Facility | 2401 South 11th Street, Moorhead, MN 56560 | 2011-02-01 |
| 1972814846 | Paul Michael Fluto | Pharmacist | 3000 Hwy 10 East, Mooehead, MN 56560 | 2010-06-25 |
| Find all providers in zip 56560 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093953366 | John Michael Tinjum | Internal Medicine | 4000 28th Ave S, Moorhead, MN 56560-7926 | 2009-01-26 |
| 1154343705 | Michael L Sand | Internal Medicine | 1301 8th St S, Moorhead, MN 56560-3604 | 2006-07-24 |
| 1861414435 | Heidi L Twedt | Internal Medicine | 1301 8th St S, Moorhead, MN 56560-3604 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295359495 | Julie Ann Schroeder | Internal Medicine | 14370 Guthrie Ave, Apple Valley, MN 55124-6729 | 2020-06-03 |
| 1023644069 | Jeffrey Howard Mandel | Internal Medicine | 6204 Westridge Blvd, Edina, MN 55436-2569 | 2020-03-22 |
| 1861032054 | David Gregg | Internal Medicine | 5305 Humboldt Ave S, Minneapolis, MN 55419 | 2020-01-15 |
| 1467969907 | Minneapolis Health Clinic Pllc | Internal Medicine | 4825 Olson Memorial Hwy., Suite 101, Golden Valley, MN 55422 | 2018-01-05 |
| 1316454077 | Independent Medical Clinic Pa | Internal Medicine | 2639 Nicollet Ave Ste 120, Minneapolis, MN 55408-1629 | 2018-01-03 |
| 1669905618 | Joseph Douglas Steffens | Internal Medicine | 701 Park Avenue, Internal Medicine Residency Program, Hennepin County Medical Center, Minneapolis, MN 55415 | 2017-04-06 |
| 1841650306 | Megan Mcgovern | Internal Medicine | 701 Park Ave # O1.340, Minneapolis, MN 55415-1623 | 2016-02-26 |
| 1255717617 | Mary S. Salter, Md Psc | Internal Medicine | 514 Beltrami Ave Nw Suite 102, Bemidji, MN 56601 | 2015-08-07 |
| 1700266079 | Jacob Wagner | Internal Medicine | D638 Mayo Building, 420 Delaware St Se, Minneapolis, MN 55455 | 2015-06-02 |
| 1659750503 | Melissa Ann Plesac | Internal Medicine | 500 Harvard St Se # 741, Minneapolis, MN 55455 | 2015-05-26 |
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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.