Organization
SANFORD CLINIC NORTH
Active
Other names
Sanford South University
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA K LECLERC (VP)
(701) 234-6248
Entity
Organization
Contact information
Practice address
1720 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 280-4150
Mailing address
1720 UNIVERSITY DR S, FARGO, ND 58103-4940
(701) 280-4150
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
876461100
—
MN
Enumeration date
07/21/2006
Last updated
11/27/2023
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