SANFORD MEDICAL CENTER FARGO (NPI# 1174120281) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174120281 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Practice Address |
5225 23rd Ave S Fargo ND 58104-7927 |
| Practice Telephone | 7014172340 |
| Practice Fax Number | 7012347476 |
| Mailing Telephone | 7012342121 |
| Mailing Fax Number | 7012347476 |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2020-10-02 |
| Authorized Official Name | TONY LEE MORRISON (VICE PRESIDENT, REVENUE CYCLE) |
| Authorized Official Telephone | 6053288380 |
| Is Organization Subpart | Y |
| Parent Organization Name | SANFORD MEDICAL CENTER FARGO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | Suppliers |
| Other Name | Type Code |
|---|---|
| Sanford Pharmacy I94 340B | 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 |
| 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 |
| 1861772162 | Sanford Medical Center Fargo | Internal Medicine | 1412 Main Street, Hawley, MN 56549-0746 | 2011-08-18 |
| 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 |
5225 23RD AVE S |
| City | FARGO |
| State | ND |
| Zip Code | 58104-7927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730141466 | Edgardo Abad Crisostomo | Psychiatry & Neurology | 5225 23rd Ave S, Fargo, ND 58104 | 2006-04-06 |
| 1881295814 | Kelsey Kincaid | Dietitian, Registered | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-11-05 |
| 1598365819 | Hannah Muehlberg | Occupational Therapist | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-10-27 |
| 1932714169 | Ashraf Al-tarifi | Internal Medicine | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-09-14 |
| 1821609116 | Heidi Nelson | Occupational Therapist | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-08-11 |
| 1689284671 | Lindsay Raye Busse | Nurse Practitioner | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-08-04 |
| 1356950752 | Jordan Mallery | Internal Medicine | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-07-31 |
| 1093324014 | Dalton James Peaslee | Internal Medicine | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-07-27 |
| 1285243543 | Mathew Gerving | Internal Medicine | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-07-23 |
| 1669081840 | Shannon Hagan Chamberlain | Internal Medicine | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2020-07-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043837347 | Pinnacle Therapy & Wellness, Pllc | Physical Therapist | 4500 36th Ave S Suite 100, Fargo, ND 58104 | 2020-07-02 |
| 1619509858 | Patricia Helen Bathie | Counselor | 4243 Auburn Ave., Fargo, ND 58104 | 2020-02-05 |
| 1346892866 | Elizabeth Olis | Registered Nurse | 2633 55th St. S, Apartment 202, Fargo, ND 58104 | 2019-07-15 |
| 1780247023 | Keith Kirimi Ndege | Physical Therapy Assistant | 5225 23rd Ave South, Fargo, ND 58104 | 2019-04-22 |
| 1346728557 | Ms4 Pllc | Pharmacy | 4476 31st Avenue South, Suite #105, Fargo, ND 58104 | 2018-07-31 |
| 1891286977 | Jessica Rae Majidian | Dentist | 3030 49th St S, Fargo, ND 58104 | 2018-05-23 |
| 1821588500 | Alissa Nichole Larson | Pharmacist | 5675 26th Ave S St. 136a, Fargo, ND 58104 | 2018-05-17 |
| 1790297430 | Northern Lights Dental | Dentist | 4150 19th Ave S, Suite 301, Fargo, ND 58104 | 2017-11-03 |
| 1619406733 | Cobalt Rehabilitation Hospital Fargo LLC | Rehabilitation Hospital | 4671 38th Street S, Fargo, ND 58104 | 2017-06-12 |
| 1790210318 | Homefield Health, LLC | Clinic/Center | 4141 31st Ave S., Ste 102, Fargo, ND 58104 | 2017-04-21 |
| Find all providers in zip 58104 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| 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: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346728557 | Ms4 Pllc | Pharmacy | 4476 31st Avenue South, Suite #105, Fargo, ND 58104 | 2018-07-31 |
| 1336472505 | Midwest Drug Distribution Inc | Pharmacy | 4153 12 Th Ave. North Suite B, Fargo, ND 58102 | 2009-09-04 |
| 1518098219 | Pharmacare Inc | Pharmacy | 2345 25th St S, Suite C, Fargo, ND 58103-6173 | 2007-03-07 |
| 1588724728 | Metro Drug Co | Pharmacy | 123 Broadway N, Fargo, ND 58102-4925 | 2006-12-11 |
| 1558458844 | Sanford Medical Center Fargo | Pharmacy | 1720 S University Drive, Fargo, ND 58103-4940 | 2006-10-06 |
| 1881785053 | Thrifty Drug Limited | Pharmacy | 1532 32nd Ave S, Fargo, ND 58103-5987 | 2006-09-27 |
| 1952407892 | Thrifty Drug Limited | Pharmacy | 1521 University Dr S, Fargo, ND 58103-4169 | 2006-09-16 |
| 1447362454 | W W Inc | Pharmacy | 2800 Broadway N, Fargo, ND 58102-1420 | 2006-08-31 |
| 1538271549 | Ww Inc | Pharmacy | 1605 University Dr S, Fargo, ND 58103-4154 | 2006-08-31 |
| 1912954165 | Medical Pharmacy South Inc | Pharmacy | 4151 45th St S, Fargo, ND 58104-4312 | 2006-05-30 |
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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.