SANFORD MEDICAL CENTER FARGO (NPI# 1366604662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366604662 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD PSYCHOLOGY |
| Practice Address |
1711 University Dr S Fargo ND 58103-4939 |
| Mailing Address |
801 Broadway N Fargo ND 58122-0605 |
| Practice Telephone | 7014615600 |
| Mailing Telephone | 7014615600 |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | MARTHA K LECLERC (VP) |
| Authorized Official Telephone | 7012346248 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
5068A | ND | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BCBS OF MN | 1466KLU | 01 |
| Other Name | Type Code |
|---|---|
| Sanford Psychology | Other Name - Individual/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 |
1711 UNIVERSITY DR S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-4939 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992896815 | Julie Huewe | Occupational Therapist | 1711 University Dr S, Fargo, ND 58103-4939 | 2006-09-27 |
| 1316341647 | Janine Saxerud | Occupational Therapist | 1711 University Dr S, Fargo, ND 58103-4939 | 2014-10-15 |
| 1649604869 | Daniel Barrett Landauer | Psychologist | 1711 University Dr S, Fargo, ND 58103-4939 | 2013-08-23 |
| 1801977798 | Kristin M Hauschild | Occupational Therapist | 1711 University Dr S, Fargo, ND 58103-4939 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609492016 | Igniting Your Change | Clinic/Center | 1222 4th Ave N Apt 318, Fargo, ND 58102-4374 | 2020-06-22 |
| 1316569767 | Goetz Mental Wellness Initiative | Clinic/Center | 3911 20th Ave S, Fargo, ND 58103-4705 | 2020-05-08 |
| 1912551797 | Helm Therapy Services, LLC | Clinic/Center | 1330 Page Dr S Ste 102a, Fargo, ND 58103-3562 | 2019-07-30 |
| 1184278004 | Dr. Kayla Moorer, Psychologist, LLC | Clinic/Center | 1330 Page Dr S Ste 102a, Fargo, ND 58103-3562 | 2019-07-29 |
| 1235799842 | Solace Counseling Pllc | Clinic/Center | 1321 23rd St S Ste D, Fargo, ND 58103-3724 | 2019-06-17 |
| 1336702687 | Altendorf Counseling | Clinic/Center | 1351 Page Dr S Ste 100, Fargo, ND 58103-3536 | 2019-04-22 |
| 1790254191 | Clarion Counseling & Consulting, LLC | Clinic/Center | 417 Main Ave Ste 302, Fargo, ND 58103-1956 | 2018-11-15 |
| 1609362888 | Hansen Hearts Counseling, Pllc | Clinic/Center | 3309 Fiechtner Dr S Ste H, Fargo, ND 58103-2375 | 2018-07-10 |
| 1659807949 | Insight Behavioral Health Partners | Clinic/Center | 4357 13th Ave S Ste 104, Fargo, ND 58103-3381 | 2017-05-04 |
| 1225459027 | Lutheran Social Services of Nd | Clinic/Center | 3911 20th Ave S, Fargo, ND 58107 | 2013-12-20 |
| Find all providers in FARGO | ||||
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.