| Sanford Health Ellendale Clinic | |
|
141 Main Street Ellendale ND 58436-7101 | |
| (701) 349-3331 | |
| (701) 349-3212 |
| Full Name | Sanford Health Ellendale Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 141 Main Street, Ellendale, 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 Health Ellendale Clinic Po Box 2168 Fargo ND 58107-2168 Ph: (701) 234-2119 | Sanford Health Ellendale Clinic 141 Main Street Ellendale ND 58436-7101 Ph: (701) 349-3331 |
| NPI Number | 1346256682 |
|---|---|
| Provider Enumeration Date | 07/31/2006 |
| Last Update Date | 11/29/2022 |
| Medicare PECOS PAC ID | 8426967803 |
|---|---|
| Medicare Enrollment ID | O20221129001428 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346256682 | NPI | - | NPPES |
| 12857 | Medicaid | ND | |
| 5133 | Medicaid | ND | |
| CF8850 | Other | RAILROAD MEDICARE | |
| 1332001 | Other | ND | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Avera Clinic Of Ellendale Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 240 Main St, Ellendale, ND 58436 Phone: 701-349-3666 Fax: 701-349-4945 |