Provider Demographics
NPI:1366478760
Name:SANFORD HEALTH NETWORK NORTH
Entity type:Organization
Organization Name:SANFORD HEALTH NETWORK NORTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-234-1094
Mailing Address - Street 1:600 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58257-1518
Mailing Address - Country:US
Mailing Address - Phone:701-788-4500
Mailing Address - Fax:701-788-4545
Practice Address - Street 1:600 1ST ST SE
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:ND
Practice Address - Zip Code:58257-1518
Practice Address - Country:US
Practice Address - Phone:701-788-4500
Practice Address - Fax:701-788-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15664Medicaid
MN079016800Medicaid
ND15666Medicaid
NDDR5473OtherRR MEDICARE
ND15666Medicaid