| Sanford Medical Center Fargo | |
|
336 Main Street Forman ND 58032-0184 | |
| (701) 724-3221 | |
| (701) 724-3222 |
| Full Name | Sanford Medical Center Fargo |
|---|---|
| Speciality | Clinic/Center |
| Location | 336 Main Street, Forman, North Dakota |
| Authorized Official Name and Position | Tony Lee Morrison (VICE PRESIDENT, REVENUE CYCLE) |
| Authorized Official Contact | 6053288380 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sanford Medical Center Fargo Po Box 2168 Fargo ND 58107-2168 Ph: (701) 234-2119 | Sanford Medical Center Fargo 336 Main Street Forman ND 58032-0184 Ph: (701) 724-3221 |
| NPI Number | 1073520003 |
|---|---|
| Provider Enumeration Date | 08/02/2006 |
| Last Update Date | 11/29/2022 |
| Medicare PECOS PAC ID | 8426967803 |
|---|---|
| Medicare Enrollment ID | O20221227001238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073520003 | NPI | - | NPPES |
| 1331001 | Other | ND | BLUE SHIELD |
| 12857 | Medicaid | ND | |
| 5128 | Medicaid | ND | |
| CF8850 | Other | ND | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |