SANFORD MEDICAL CENTER FARGO (NPI# 1295015535) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295015535 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD HEALTH WAHPETON CLINIC |
| Practice Address |
332 2nd Ave N Wahpeton ND 58075-4528 |
| Practice Telephone | 7016427000 |
| Mailing Telephone | 7016427000 |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2019-11-26 |
| 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 | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Sanford Health Wahpeton 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 |
332 2ND AVE N |
| City | WAHPETON |
| State | ND |
| Zip Code | 58075-4528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720075666 | Lisa R. Braun | Physician Assistant | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2005-10-05 |
| 1851896112 | Kara Ann Trom | Registered Nurse | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2018-03-28 |
| 1336599083 | Mary Isom | Physician Assistant | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2016-06-14 |
| 1700230554 | Theodore (ted) Haskin | Family Medicine | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2016-04-18 |
| 1255704318 | Mandy Naumann | Physical Therapist | 332 2nd Ave N, Wahpeton, ND 58075 | 2015-11-10 |
| 1902276835 | Daniel William Johnson | Physical Therapist | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2015-10-05 |
| 1144662719 | Brooke Rae Heitkamp Hills | Nurse Practitioner | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2013-07-24 |
| 1568706349 | Kelsey Jo Kent | Occupational Therapist | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2012-11-19 |
| 1588945919 | Ariane M Getz | Psychologist | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2011-08-30 |
| 1164702460 | Sanford Medical Center Fargo | Eyewear Supplier (Equipment, not the service) | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2011-08-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861745838 | Benedictine Living Community of Wahpeton | Skilled Nursing Facility | 711 14th Avenue North, Wahpeton, ND 58075 | 2012-10-16 |
| 1538385844 | Michelle Catherine Stach | Physical Therapy Assistant | 1307 4 Ave North, Wahpeton, ND 58075 | 2007-04-17 |
| 1881717122 | Red River Human Services Foundation | Intermediate Care Facility, Mentally Retarded | 1348 15th Av N, Wahpeton, ND 58075 | 2007-04-10 |
| 1972626216 | Red River Human Services Foundation | Intermediate Care Facility, Mentally Retarded | 821 Western Rd, Wahpeton, ND 58075 | 2007-04-10 |
| 1700908589 | Red River Human Services Foundation | Intermediate Care Facility, Mentally Retarded | 348 14th St N, Wahpeton, ND 58075 | 2007-04-04 |
| 1275626053 | Richland County | Public Health or Welfare | 413 3rd Avenue North, Wahpeton, ND 58075 | 2006-10-02 |
| 1962503896 | Brian James Quamme | Dentist | 910 16th Ave N, Wahpeton, ND 58075 | 2006-09-25 |
| 1083720114 | Judith Kay Schmidt | Dentist | 2005 Woodland Drive, Wahpeton, ND 58075 | 2006-08-22 |
| 1891240354 | Concept Dentistry PC | Dentist | 1999 4th St N, Wahpeton, ND 58075 | 2016-08-24 |
| 1457677130 | Midwest Vision Centers, Inc. | Optometrist | 517 Dakota Ave, Wahpeton, ND 58075 | 2010-04-20 |
| Find all providers in zip 58075 | ||||
| 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 |
|---|---|---|---|---|
| 1114199635 | Medical Arts Physicians Ltd | Family Medicine | 614 Dakota Ave, Wahpeton, ND 58075-4300 | 2008-03-25 |
| 1841264892 | Kristina England | Family Medicine | 275 11th St S, Wahpeton, ND 58075-4655 | 2006-02-15 |
| 1700230554 | Theodore (ted) Haskin | Family Medicine | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2016-04-18 |
| 1467614503 | Winter Marie Ackerman | Family Medicine | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2008-06-30 |
| 1790965440 | Innovis Health, LLC. | Family Medicine | 275 11th St S, Wahpeton, ND 58075-4655 | 2007-11-10 |
| 1124222351 | Timothy Monari Nyarandi | Family Medicine | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2007-06-12 |
| 1174617732 | Susan K Nelson | Family Medicine | 275 11th St S, Wahpeton, ND 58075-4655 | 2006-10-03 |
| 1770504011 | Garry A Mislan | Family Medicine | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2006-07-22 |
| 1144247008 | Patrick E Emery | Family Medicine | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2006-07-16 |
| 1750313946 | William M Mayo | Family Medicine | 332 2nd Ave N, Wahpeton, ND 58075-4528 | 2006-07-07 |
| Find all providers in WAHPETON | ||||
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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.