SANFORD MEDICAL CENTER FARGO (NPI# 1366722647) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366722647 |
| Entity Type | Organization |
| Organization Name | SANFORD MEDICAL CENTER FARGO |
| Other Organization Name | PERHAM HEALTH NEW YORK MILLS CLINIC |
| Practice Address |
20 W Centennial 84 Drive New York Mills MN 56567-0364 |
| Mailing Address |
Po Box D 20 W Centennial 84 Drive New York Mills MN 56567-0364 |
| Practice Telephone | 2183851800 |
| Mailing Telephone | 2183851800 |
| Enumeration Date | 2011-08-18 |
| 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 |
|---|---|---|---|---|---|
| N | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
Eye and Vision Services Providers | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Perham Health New York Mills 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 |
20 W CENTENNIAL 84 DRIVE |
| City | NEW YORK MILLS |
| State | MN |
| Zip Code | 56567-0364 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154343176 | Sanford Clinic North | Optometrist | 20 W Centennial 84 Drive, New York Mills, MN 56567-0364 | 2006-07-25 |
| 1801176268 | Perham Hospital District | Internal Medicine | 20 W Centennial 84 Drive, New York Mills, MN 56567-0364 | 2011-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164730362 | Otter Tail County Public Health | Public Health or Welfare | 118 North Main Avenue, New York Mills, MN 56567 | 2010-09-22 |
| 1740419696 | Josephine Annette Wigert | Community Health Worker | 118 North Main St., New York Mills, MN 56567 | 2009-07-13 |
| 1629204425 | Paula Rae Martenson | Registered Nurse | 118 N Main Ave, Box 99, New York Mills, MN 56567 | 2009-06-08 |
| 1689703365 | Ksteinbach, Inc | Home Health | 42690 Cty Hwy 67, New York Mills, MN 56567 | 2007-03-05 |
| 1316002488 | Independent School District 553 | Local Education Agency (LEA) | 209 Hayes St, New York Mills, MN 56567 | 2006-12-27 |
| 1750302972 | Thomas M Seaworth | Family Medicine | 20 Centennial 84 Dr W, New York Mills, MN 56567 | 2006-07-22 |
| 1356321624 | Elders Home Inc | Skilled Nursing Facility | 215 S Tousley Ave, New York Mills, MN 56567 | 2006-01-20 |
| 1285655407 | Timothy J Studer | Family Medicine | 20 Centennial 84 Dr W, New York Mills, MN 56567 | 2006-07-22 |
| 1811123573 | Jodi Lynn Misegades | Registered Nurse | 118 Main Avenue North, New York Mills, MN 56567-0099 | 2009-06-08 |
| 1013143924 | Joann Winjum | Registered Nurse | 118 No. Main St., New York Mills, MN 56567-0099 | 2009-06-05 |
| Find all providers in zip 56567 | ||||
| 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 |
|---|---|---|---|---|
| 1750302972 | Thomas M Seaworth | Family Medicine | 20 Centennial 84 Dr W, New York Mills, MN 56567 | 2006-07-22 |
| 1649232273 | Marylee S. Legried | Family Medicine | 53208 395th St, New York Mills, MN 56567-9031 | 2006-04-06 |
| 1285655407 | Timothy J Studer | Family Medicine | 20 Centennial 84 Dr W, New York Mills, MN 56567 | 2006-07-22 |
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| 1477196715 | The Doctors Medical Clinic, P.a. | Family Medicine | 1504 Whitebear Ave, St Paul, MN 55106 | 2019-10-18 |
| 1699336511 | Ruth Archibald | Family Medicine | 6962 Cottonwood Ct Nw, Rochester, MN 55901-8835 | 2019-06-21 |
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| 1558834390 | Donna Mae Mullenix | Family Medicine | 2849 Cty Rd 103, Barnum, MN 55707 | 2019-01-04 |
| 1083189203 | Altru Health System | Family Medicine | 23076 347th Street Se, Erskine, MN 56535-9466 | 2018-10-04 |
| 1477039204 | Dollar Clinic Pllc | Family Medicine | 1002 1st Ave N, Moorhead, MN 56560-2003 | 2018-07-16 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| Find all providers with the same taxonomy | ||||
| City | NEW YORK MILLS |
| Zip Code | 56567 |
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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.