Organization
SANFORD CLINIC NORTH
Active
Other names
Sanford Bemidji Cass Lake Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA K LECLERC (VP)
(701) 234-6248
Entity
Organization
Contact information
Practice address
219 GRANT UTLEY AVENUE NW, CASS LAKE, MN 56633-0067
(218) 335-2559
(218) 335-2755
Mailing address
720 4TH ST N, PO BOX 2010, FARGO, ND 58122-0605
(218) 335-2559
(218) 335-2755
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
961888100
—
MN
Enumeration date
07/11/2006
Last updated
11/02/2011
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