Organization
SANFORD MEDICAL CENTER FARGO
Active
Organization
SANFORD MEDICAL CENTER FARGO
Active
Other names
Sanford Broadway Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA LECLERC (VICE PRESIDENT)
(701) 234-6248
Entity
Organization
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2000
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2000
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
204F00000X
Transplant Surgery Physician
—
—
207K00000X
Allergy & Immunology Physician
—
—
207L00000X
Anesthesiology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207ZP0101X
Anatomic Pathology Physician
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Enumeration date
08/18/2011
Last updated
11/27/2023
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