SANFORD MEDICAL CENTER FARGO (NPI# 1093095382) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093095382 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD BEMIDJI MAIN CLINIC |
| Practice Address |
1233 34th St Nw Bemidji MN 56601-5112 |
| Practice Telephone | 2183335000 |
| Mailing Telephone | 2183335000 |
| 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 | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 207ZP0101X |
Pathology Specialization: Anatomic Pathology |
Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Sanford Bemidji Main 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 |
1233 34TH ST NW |
| City | BEMIDJI |
| State | MN |
| Zip Code | 56601-5112 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093775900 | David Alan Vanengelenhoven | Emergency Medicine | 1233 34th St Nw, Meritcare Clinic, Bemidji, MN 56601 | 2006-03-24 |
| 1467063297 | Melissa Cook | Social Worker | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2020-08-14 |
| 1669961561 | Sanford Clinic North | Durable Medical Equipment & Medical Supplies | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2018-05-07 |
| 1164956645 | Sanford Clinic North | Pharmacist | 1233 34th St Nw, Sanford Clinic Pharmacy, Bemidji, MN 56601-5112 | 2017-04-12 |
| 1982055661 | Emmanuel Ortiz Erestain | Internal Medicine | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2016-06-24 |
| 1821407453 | Jennifer Leonhard | Genetic Counselor, MS | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2014-08-07 |
| 1235553140 | Gretchen Lee Bonik | Pharmacist | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2014-02-12 |
| 1023350949 | Terry Joseph Luma | Family Medicine | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2013-03-18 |
| 1841544160 | Brittany Dawn Smith | Dietitian, Registered | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2012-11-08 |
| 1043565757 | Jayasri Alapati | Psychiatry & Neurology | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2012-07-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772425 | Northern Minnesota Addiction Wellness Center | Substance Abuse Rehabilitation Facility | 4851 Stacy Ann Dr Nw, Bemidji, MN 56601 | 2020-02-17 |
| 1366093841 | Vickie Lynn Matthews | Technician | 1018 Miles Ave Se, Bemidji, MN 56601 | 2019-09-25 |
| 1518443530 | Lindsey Marie Whiting | Registered Nurse | 1300 Anne St, Bemidji, MN 56601 | 2018-07-12 |
| 1801257662 | Meghan Zigrida Paquette | Registered Nurse | 6055 161st Street Nw, Cass Lake, MN 56601 | 2016-03-08 |
| 1144686106 | Northwest Indian Oic | Home Health | 1819 Bemidji Ave N Ste 1, Bemidji, MN 56601 | 2016-01-06 |
| 1831560424 | Laura Hansen, Msw, Licsw Counseling Services, Inc. | Social Worker | 403 4th Street Ne, Suite 110, Bemidji, MN 56601 | 2015-10-08 |
| 1679949028 | Grand St. Paul Cvs LLC | Durable Medical Equipment & Medical Supplies | 2312 Bemidji Ave North, Bemidji, MN 56601 | 2015-08-19 |
| 1255717617 | Mary S. Salter, Md Psc | Internal Medicine | 514 Beltrami Ave Nw Suite 102, Bemidji, MN 56601 | 2015-08-07 |
| 1225420615 | Cristin Evans | Counselor | 403 4th Street, Suite 300, Bemidji, MN 56601 | 2015-02-23 |
| 1619367919 | Angela Krom Fournier | Psychologist | 16150 Golden Eagle Court Nw, Eagle Vista Equine Center Inc., Bemidji, MN 56601 | 2015-01-26 |
| Find all providers in zip 56601 | ||||
| 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 |
|---|---|---|---|---|
| 1255717617 | Mary S. Salter, Md Psc | Internal Medicine | 514 Beltrami Ave Nw Suite 102, Bemidji, MN 56601 | 2015-08-07 |
| 1912160219 | Tracy C Blichfeldt | Internal Medicine | 705 5th St Nw Ste B, Bemidji, MN 56601-2933 | 2008-07-07 |
| 1093821621 | Mary Susanna Salter | Internal Medicine | 514 Beltrami Ave Nw, Bemidji, MN 56601-3010 | 2006-08-23 |
| 1982055661 | Emmanuel Ortiz Erestain | Internal Medicine | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2016-06-24 |
| 1063894293 | Calvin Tsogmo | Internal Medicine | 1300 Anne St Nw, Bemidji, MN 56601 | 2015-06-24 |
| 1316332141 | Danielle Tighe | Internal Medicine | 1000 Anne St Nw, Bemidji, MN 56601-5109 | 2015-03-30 |
| 1861741431 | Hani Snounou | Internal Medicine | 1300 Anne St Nw, Bemidji, MN 56601-5103 | 2012-08-29 |
| 1356605968 | Manit Singla | Internal Medicine | 1300 Anne St Nw, Bemidji, MN 56601 | 2012-06-28 |
| 1114234986 | Hina Rahman | Internal Medicine | 1233 34th St Nw, Bemidji, MN 56601-5112 | 2010-09-01 |
| 1336451665 | Elie Chalhoub | Internal Medicine | 1705 Anne St Nw, Bemidji, MN 56601-6151 | 2010-07-01 |
| Find all providers in BEMIDJI | ||||
Please comment or provide details below to improve the information on SANFORD MEDICAL CENTER FARGO.
| 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.