Organization
SANFORD CLINIC NORTH
Active
Other names
Sanford Southpointe Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA K LECLERC (VP)
(701) 234-6248
Entity
Organization
Contact information
Practice address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-8800
Mailing address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-8800
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208200000X
Plastic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
734639500
—
MN
Enumeration date
06/29/2006
Last updated
11/27/2023
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