| Sanford Medical Center Fargo | |
|
108 Viking Avenue W Ulen MN 56585 | |
| (218) 596-8867 | |
| (218) 596-8112 |
| Full Name | Sanford Medical Center Fargo |
|---|---|
| Speciality | Clinic/Center |
| Location | 108 Viking Avenue W, Ulen, Minnesota |
| 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 108 Viking Avenue W Ulen MN 56585 Ph: (218) 596-8867 |
| NPI Number | 1801818497 |
|---|---|
| Provider Enumeration Date | 07/24/2006 |
| Last Update Date | 11/29/2022 |
| Medicare PECOS PAC ID | 8426967803 |
|---|---|
| Medicare Enrollment ID | O20230104000377 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801818497 | NPI | - | NPPES |
| 098718200 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |