# SANFORD MEDICAL CENTER FARGO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sanford South University Eye Center & Optical, Sanford Health Detroit Lakes MRI, Sanford 1717 Medical Building, Sanford Hankinson Clinic, Sanford Health Hillsboro Clinic, Sanford Health 625 Demers Ave Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184917924
- **Authorized official:** TONY LEE MORRISON (VP, CHIEF REVENUE CYCLE OFFICER)
- **Authorized official phone:** (605) 328-8380

## Contact information

- **Practice address:** 1220 SHEYENNE ST, WEST FARGO, ND 58078-2637
- **Practice address phone:** (701) 234-4445
- **Mailing address:** PO BOX 2168, FARGO, ND 58107-2168

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | NULL | — |
| 207XX0004X | Orthopaedic Foot and Ankle Surgery Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | — |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |

## Other

- **Enumeration date:** 05/26/2011
- **Last updated:** 07/21/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 370579402 | FEDERAL WORKERS COMP | ND |
| 01 | — | DR6518 | RR MEDICARE | MN |
| 01 | — | DR6521 | RR MEDICARE | ND |