SANFORD DIALYSIS RED LAKE – NPI #1124189741
Clinic/Center

SANFORD DIALYSIS RED LAKE is an AHC clinic located in RED LAKE, MN. NPPES has assigned the NPI number 1124189741 to SANFORD DIALYSIS RED LAKE on December 13, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “SANFORD DIALYSIS RED LAKE” is a dba name, the actual legal business name for this organization is SANFORD MEDICAL CENTER FARGO. The primary taxonomy selected by this provider is 261QE0700X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment

The NPI profile was previously updated about 3 years ago on Nov 27, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SANFORD DIALYSIS RED LAKE below.

NPI Profile for
SANFORD MEDICAL CENTER FARGO

NPI Number
1124189741
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SANFORD MEDICAL CENTER FARGO
Doing Business As (dba): SANFORD DIALYSIS RED LAKE
Primary location
24760 HOSPITAL DR
RED LAKE, MN 56671
Phone: (218) 679-3117 Fax: (218) 676-4386
Mailing address
PO BOX 2168
FARGO, ND 58107-2168
Phone: (701) 234-2119 Fax: (701) 234-2045
Organization Subpart
No
Authorized Official
TONY MORRISON
VICE PRESIDENT, REVENUE CYCLE
Phone: (605) 328-8380
Updated
Certification Date
Jul 31, 2020

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for SANFORD DIALYSIS RED LAKE

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidMN632605600
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QE0700X
- Clinic/Center / End-Stage Renal Disease (ESRD) Treatment (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Endpoint

Health Information Exchange (HEI)

HEI is the mobilization of health care information electronically across organizations within a region, community or hospital system. Endpoints provide a simple and secure way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet such as primary care physicians, specialists, hospitals, labs, etc.

Endpoint
https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service
Endpoint type
CONNECT URL
Endpoint Description
2.16.840.1.113883.3.1068.1
Content Type
Affiliation
Y
Endpoint Location
2720 DUNDEE RD # 302,
NORTHBROOK, IL 77025-1669