Organization
SANFORD CLINIC NORTH
Active
Organization
SANFORD CLINIC NORTH
Active
Other names
Sanford Health Lidgerwood Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA K LECLERC (VP)
(701) 234-6248
Entity
Organization
Contact information
Practice address
21 WILEY AVENUE SOUTH, LIDGERWOOD, ND 58053-4001
(701) 538-4189
(701) 538-4319
Mailing address
720 FOURTH STREET S, FARGO, ND 58122-0605
(701) 234-2000
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12857
—
ND
01
—
1327001
BLUE SHIELD
ND
05
—
5135
—
ND
01
—
CF8850
RAILROAD MEDICARE
ND
Enumeration date
08/02/2006
Last updated
11/27/2023
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