SANFORD MEDICAL CENTER FARGO (NPI# 1861772162) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861772162 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD HAWLEY CLINIC |
| Practice Address |
1412 Main Street Hawley MN 56549-0746 |
| Mailing Address |
1412 Main Street Po Box 746 Hawley MN 56549-0746 |
| Practice Telephone | 2184833564 |
| Mailing Telephone | 2184833564 |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2019-11-25 |
| 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 | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Sanford Hawley 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 |
1412 MAIN STREET |
| City | HAWLEY |
| State | MN |
| Zip Code | 56549-0746 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679599864 | Harold J Herbst | Physician Assistant | 1412 Main Street, Hawley, MN 56549 | 2006-07-14 |
| 1518488071 | Carrie Lynne Holt | Nurse Practitioner | 1412 Main Street, Hawley, MN 56549 | 2017-07-05 |
| 1174761084 | Tabitha M Hass | Physician Assistant | 1412 Main Street, Hawley, MN 56549 | 2009-01-30 |
| 1578681995 | Heidi J Peterson | Nurse Practitioner | 1412 Main Street, Hawley, MN 56549 | 2007-03-26 |
| 1710909304 | Sanford Clinic North | Internal Medicine | 1412 Main Street, Hawley, MN 56549-0746 | 2006-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528146941 | Independent School District 150 | Local Education Agency (LEA) | 714 Joseph St, Hawley, MN 56549 | 2006-11-02 |
| 1063463966 | David A Vogt | Family Medicine | 1412 Main St, Hawley, MN 56549 | 2006-05-15 |
| 1285695783 | Lakes Region Artificial Limb and Brace Company Inc | Durable Medical Equipment & Medical Supplies | 710 Valley St, Hawley, MN 56549 | 2006-04-01 |
| 1619537982 | Bailey Goolsbey | Physical Therapy Assistant | 520 Main St, Hawley, MN 56549 | 2019-06-18 |
| 1053802785 | Garrett Allen Skonseng | Dentist | 520 Main St., Hawley, MN 56549 | 2018-05-29 |
| 1174014526 | Emily M Frosaker | Dentist | 520 Main St., Hawley, MN 56549 | 2018-05-22 |
| 1609387760 | Amber Hakk | Physical Therapist | 520 Main St., Hawley, MN 56549 | 2017-10-17 |
| 1548631187 | Kaitlin Siewert | Advanced Practice Dental Therapist | 520 Main Street, Hawley, MN 56549 | 2015-10-08 |
| 1871976175 | Hawley Family Dentisrty | Clinic/Center | 500 6th St, Hawley, MN 56549 | 2015-07-06 |
| 1720376874 | Tiara Leigh Applequist | Dentist | 520 South Main St, Hawley, MN 56549 | 2011-07-11 |
| Find all providers in zip 56549 | ||||
| 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 |
|---|---|---|---|---|
| 1023185543 | Keystone Family Practice of Hawley | Family Medicine | 227 Main Ave, Hawley, PA 18428-1327 | 2006-11-29 |
| 1063463966 | David A Vogt | Family Medicine | 1412 Main St, Hawley, MN 56549 | 2006-05-15 |
| 1699743450 | Susan Leigh Mowatt | Family Medicine | 619 Church St, Hawley, PA 18428-1444 | 2006-03-09 |
| 1477736254 | Wayne Memorial Community Health Centers | Family Medicine | 750 Route 739, Hawley, PA 18428-6071 | 2007-12-14 |
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| 1760005771 | Revive Pain Centers Pa | Family Medicine | 14525 Highway 7 Ste 375, Minnetonka, MN 55345-3741 | 2020-05-26 |
| 1245862697 | North Iowa Mercy Clinics | Family Medicine | 2440 Bridge Ave, Albert Lea, MN 56007-2005 | 2020-02-04 |
| 1477196715 | The Doctors Medical Clinic, P.a. | Family Medicine | 1504 Whitebear Ave, St Paul, MN 55106 | 2019-10-18 |
| 1699336511 | Ruth Archibald | Family Medicine | 6962 Cottonwood Ct Nw, Rochester, MN 55901-8835 | 2019-06-21 |
| 1295399251 | Roberta Lynn Kopel | Family Medicine | 1605 W Lincoln Ave, Olivia, MN 56277-1260 | 2019-04-25 |
| 1558834390 | Donna Mae Mullenix | Family Medicine | 2849 Cty Rd 103, Barnum, MN 55707 | 2019-01-04 |
| 1083189203 | Altru Health System | Family Medicine | 23076 347th Street Se, Erskine, MN 56535-9466 | 2018-10-04 |
| 1477039204 | Dollar Clinic Pllc | Family Medicine | 1002 1st Ave N, Moorhead, MN 56560-2003 | 2018-07-16 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
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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.