Organization
SANFORD MEDICAL CENTER FARGO
Active
Other names
Sanford Dialysis Detroit Lakes
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
1234 WASHINGTON AVE STE B, DETROIT LAKES, MN 56501-3906
(218) 846-2200
(218) 846-2201
Mailing address
PO BOX 2168, FARGO, ND 58107-2168
(701) 234-2119
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012096
NDBC
—
01
—
1C18HME
MNBC
—
05
—
735547500
—
MN
Enumeration date
06/18/2006
Last updated
07/02/2020
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