Organization
SANFORD CLINIC NORTH
Active
Other names
Sanford Children's Southwest Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA K LECLERC (VP)
(701) 234-6248
Entity
Organization
Contact information
Practice address
2701 13TH AVE S, FARGO, ND 58103-3602
(701) 234-3600
(701) 234-3528
Mailing address
2701 13TH AVE S, FARGO, ND 58103-3602
(701) 234-3600
(701) 234-3528
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086712800
—
MN
Enumeration date
06/29/2006
Last updated
11/27/2023
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