| St. Sophie's, Llc | |
|
3201 33rd St S Fargo ND 58104-8823 | |
| (701) 365-4488 | |
| (701) 365-0727 |
| Full Name | St. Sophie's, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3201 33rd St S, Fargo, North Dakota |
| Authorized Official Name and Position | Tracey Jean Frei (OFFICE MANAGER) |
| Authorized Official Contact | 7013654467 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Sophie's, Llc 3201 33rd St S Fargo ND 58104-8823 Ph: (701) 365-4488 | St. Sophie's, Llc 3201 33rd St S Fargo ND 58104-8823 Ph: (701) 365-4488 |
| NPI Number | 1336443654 |
|---|---|
| Provider Enumeration Date | 12/29/2010 |
| Last Update Date | 04/30/2014 |
| Medicare PECOS PAC ID | 7113195074 |
|---|---|
| Medicare Enrollment ID | O20110719000878 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336443654 | NPI | - | NPPES |
| 15685 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 7174 (North Dakota) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 7174 (North Dakota) | Primary |
| Provider Name | Emmet M Kenney |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902998081 PECOS PAC ID: 9436140670 Enrollment ID: I20040518001264 |
| Provider Name | Randy Swingen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861637852 PECOS PAC ID: 5597829481 Enrollment ID: I20090121000219 |
| Provider Name | Aminata Kamara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578127288 PECOS PAC ID: 2062844863 Enrollment ID: I20191116000408 |
| Provider Name | Rachel Sauter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134781321 PECOS PAC ID: 9335572700 Enrollment ID: I20191126001403 |
| Provider Name | Stephanie A Akers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609443597 PECOS PAC ID: 3274916473 Enrollment ID: I20220822001632 |
| Provider Name | Nicole Albaugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548909229 PECOS PAC ID: 1254707227 Enrollment ID: I20221015000192 |
| Provider Name | Thomas Ugelstad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285373738 PECOS PAC ID: 4486024411 Enrollment ID: I20230106002692 |
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