Organization
SANFORD MEDICAL CENTER FARGO
Active
Other names
Sanford Health Mahnomen Clinic
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
410 4TH ST NW, MAHNOMEN, MN 56557-4208
(218) 935-2514
(218) 935-2720
Mailing address
PO BOX 2168, FARGO, ND 58107-2168
(701) 234-2119
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
954222100
—
MN
Enumeration date
06/11/2006
Last updated
11/29/2022
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