COMMUNITY UPLIFT PROGRAM (NPI# 1538661384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538661384 |
| Entity Type | Organization |
| Organization Name | COMMUNITY UPLIFT PROGRAM |
| Other Organization Name | HARBOR HEALTH CLINIC |
| Practice Address |
417 Main Ave Ste 401 Fargo ND 58103-1956 |
| Mailing Address |
Po Box 909 Fargo ND 58107-0909 |
| Practice Telephone | 7017997314 |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2018-10-12 |
| Authorized Official Name | CODY SEVERSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7016393094 |
| Is Organization Subpart | Y |
| Parent Organization Name | COMMUNITY UPLIFT PROGRAM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Harbor Health Clinic | Doing Business As Name - Organization |
| Street Address |
417 MAIN AVE STE 401 |
| City | FARGO |
| State | ND |
| Zip Code | 58103-1956 |
| 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 | 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 |
|---|---|---|---|---|
| 1679068035 | Rory Ratzlaff | Family Medicine | Sanford Health 737 Broadway N, Fargo, ND 58122-0001 | 2018-06-28 |
| 1710472725 | Shabnum Gupta | Family Medicine | Sanford Health 801 Broadway North, Fargo, ND 58122-0170 | 2018-06-22 |
| 1841576279 | Michelle Vonrueden | Family Medicine | 1018 18th St S, Fargo, ND 58103-2926 | 2011-10-31 |
| 1801174768 | Vidya Vijayaraghavan | Family Medicine | 4689 38th Ave S, Fargo, ND 58104-8506 | 2011-07-26 |
| 1275762924 | Sreejith Gopi | Family Medicine | 4110 51st Avenue South, Fargo, ND 58104 | 2009-07-02 |
| 1356537781 | Terry L Wolff | Family Medicine | 2700 12th Ave Sw, Suite D, Fargo, ND 58103 | 2007-09-19 |
| 1144436338 | Daniel Wilfred Herold | Family Medicine | 225 4th Ave N, Fargo Meps, Fargo, ND 58102-4841 | 2007-05-15 |
| 1679619860 | Carl John Fedyszyn, M.d.,p.c. | Family Medicine | 4550 47th St S Apt 102, Fargo, ND 58104-4360 | 2007-01-29 |
| 1417040189 | Michelle M Radke | Family Medicine | 1711 Gold Drive South Suite 160, Fargo, ND 58103 | 2006-10-02 |
| 1659477149 | Independent Family Doctors | Family Medicine | 1711 Gold Dr S Ste 160, Fargo, ND 58103-6418 | 2006-09-15 |
| Find all providers in FARGO | ||||
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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.