# SANFORD CLINIC NORTH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sanford Children's Southwest Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033147046
- **Authorized official:** MARTHA K LECLERC (VP)
- **Authorized official phone:** (701) 234-6248

## Contact information

- **Practice address:** 2701 13TH AVE S, FARGO, ND 58103-3602
- **Practice address phone:** (701) 234-3600
- **Practice address fax:** (701) 234-3528
- **Mailing address:** 2701 13TH AVE S, FARGO, ND 58103-3602
- **Mailing address phone:** (701) 234-3600
- **Mailing address fax:** (701) 234-3528

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/29/2006
- **Last updated:** 11/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 086712800 | — | MN |