SANFORD MEDICAL CENTER FARGO (NPI# 1366717118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366717118 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | SANFORD DIALYSIS DETROIT LAKES |
| Practice Address |
1245 Washington Ave Detroit Lakes MN 56501-3905 |
| Mailing Address |
801 Broadway N Po Box 2010 Fargo ND 58102-3641 |
| Practice Telephone | 2188462000 |
| Mailing Telephone | 2188462000 |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | TIFFANY LAWRENCE (CFO) |
| Authorized Official Telephone | 7012346449 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
5018 | ND | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Sanford Dialysis Detroit Lakes | 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 |
| 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 |
1245 WASHINGTON AVE |
| City | DETROIT LAKES |
| State | MN |
| Zip Code | 56501-3905 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871582643 | Mark David Lindquist | Family Medicine | 1245 Washington Ave, Detroit Lakes, MN 56501 | 2005-10-14 |
| 1467013896 | Jessica Rosenau | Physical Therapist | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2019-06-26 |
| 1538513155 | Molly Marie Anderson | Family Medicine | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2016-04-20 |
| 1073975462 | Max Disse | Dermatology | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2016-03-24 |
| 1578950887 | Mathew Malek | Surgery | 1245 Washington Ave, Detroit Lakes, MN 56501-3923 | 2015-04-24 |
| 1811391915 | Kathyrn J Moe | Nutritionist | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2014-10-17 |
| 1740683796 | Tina Mcdonald | Occupational Therapist | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2014-10-06 |
| 1457799652 | Leah M Hochstein | Nurse Practitioner | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2013-06-10 |
| 1508109661 | Mary Jane Richter | Audiologist | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2013-03-27 |
| 1982941860 | Angela M Weaver | Occupational Therapist | 1245 Washington Ave, Detroit Lakes, MN 56501-3905 | 2013-01-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265649 | Candace Louise Haugtvedt | Pharmacist | 321 Us-10 West, Detroit Lakes, MN 56501 | 2020-11-05 |
| 1679068407 | Strive Chiropractic Detroit Lakes LLC | Chiropractor | 1852 Nodaway Drive, Detroit Lakes, MN 56501 | 2018-06-25 |
| 1194215830 | Jordan James Reese | Registered Nurse | 1295 Bay Ridge Dr, Detroit Lakes, MN 56501 | 2018-05-17 |
| 1992179386 | Compassion House | Substance Abuse Rehabilitation Facility | 811 8th St. Se, Detroit Lakes, MN 56501 | 2015-11-23 |
| 1720344286 | Lakes Crisis & Resource Center | Clinic/Center | 1339 Pelican Lane, Detroit Lakes, MN 56501 | 2012-04-09 |
| 1063657120 | Diane Jean Mccormack | Occupational Therapist | 15840 Long Lake Road, Detroit Lakes, MN 56501 | 2008-12-03 |
| 1588817928 | Darcy Caleb Olson | Counselor | 925 Lake Ave, Detroit Lakes, MN 56501 | 2008-10-29 |
| 1760651079 | Rapidcare Urgent Care Pllc | Family Medicine | 1361 Wenner Road, Detroit Lakes, MN 56501 | 2008-02-21 |
| 1427274729 | Jeffrey C Gregory | Psychologist | 910 Lincoln Ave, Detroit Lakes, MN 56501 | 2007-04-17 |
| 1144364894 | Midwest Vision Centers Inc | Eyewear Supplier (Equipment, not the service) | 830 Washington Avenue, Detroit Lakes, MN 56501 | 2007-02-16 |
| Find all providers in zip 56501 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578508198 | Sanford Medical Center Fargo | Clinic/Center | 1234 Washington Ave Ste B, Detroit Lakes, MN 56501-3906 | 2006-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770183832 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 6160 Summit Dr N Ste 150, Brooklyn Center, MN 55430-2118 | 2020-10-28 |
| 1902392111 | Chaffee Dialysis LLC | Clinic/Center | 862 Arcade St, Saint Paul, MN 55106 | 2018-07-11 |
| 1225541055 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 7433 Currell Blvd, Woodbury, MN 55125-2217 | 2017-11-15 |
| 1154856839 | Avera Marshall | Clinic/Center | 300 S Bruce St Ste D, Marshall, MN 56258-1934 | 2017-05-01 |
| 1225573777 | Atlantic Dialysis LLC | Clinic/Center | 1802 Commerce Dr, North Mankato, MN 56003-1800 | 2016-12-19 |
| 1437694981 | Atlantic Dialysis LLC | Clinic/Center | 701 N Broadway St, New Ulm, MN 56073-1201 | 2016-12-19 |
| 1467801860 | Total Renal Care, Inc. | Clinic/Center | 20184 Heritage Dr, Lakeville, MN 55044-6855 | 2016-06-07 |
| 1003292392 | Bio-medical Applications of Minnesota, Inc. | Clinic/Center | 17592 Dodd Blvd, Lakeville, MN 55044-3909 | 2015-08-10 |
| 1629461470 | Babler Dialysis, LLC | Clinic/Center | 2660 S Broadway, Ste A, Rochester, MN 55904-6263 | 2015-03-17 |
| 1588067391 | Meesa Dialysis LLC | Clinic/Center | 245 Isle St W, Isle, MN 56342-4908 | 2014-10-07 |
| Find all providers with the same taxonomy | ||||
| City | DETROIT LAKES |
| Zip Code | 56501 |
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.