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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