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Organization
SANFORD MEDICAL CENTER FARGO
Active
Organization
SANFORD MEDICAL CENTER FARGO
Active
Other names
Sanford Pharmacy Moorhead
Organization subpart
No
Provider details
NPI number
Authorized official
TONY LEE MORRISON (VICE PRESIDENT, REVENUE CYCLE)
(605) 328-8380
Entity
Organization
Contact information
Practice address
4000 28TH AVE S, MOORHEAD, MN 56560
(701) 234-3250
Mailing address
4000 28TH AVE S, MOORHEAD, MN 56560-7926
(701) 234-2121
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
2602723
MN
3336C0002X
Clinic Pharmacy
Primary
2602723
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124122783
—
MN
05
—
21559
—
ND
01
—
24-17081
NCPDP
—
01
—
82-00338
MEDICA
—
Enumeration date
09/12/2006
Last updated
12/12/2023
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