MEDICARE: SANFORD CLINIC NORTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	208600000X	Surgery Physician
3	207V00000X	Obstetrics & Gynecology Physician
4	103TP0814X	Psychoanalysis Psychologist
5	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235170747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANFORD CLINIC NORTH

Provider Business Mailing Address
First Line	:	1245 WASHINGTON AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3905
Country	:	US
Telephone Number	:	218-846-2000
Fax Number	:	218-846-2114

Provider Business Practice Location Address
First Line	:	1245 WASHINGTON AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3905
Country	:	US
Telephone Number	:	218-846-2000
Fax Number	:	218-846-2114

Authorized Official
Title or Position	:	VP
Name	:	MARTHA K LECLERC
Credential	:
Telephone Number	:	701-234-6248

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/02/2011

Similar Medicare Providers

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Practice Location Address:

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56501-3905

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1699744227 — DR. JODI RAE BOERGER WILDER LP
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1629015300 — TRACY L KELLER PT
Practice Location Address:

1245 WASHINGTON AVE
DETROIT LAKES, MN
56501-3905

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1124065529 — KAREN VELASKI SCHMIT MSW
Practice Location Address:

1245 WASHINGTON AVE
DETROIT LAKES, MN
56501-3905

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1235177841 — DR. GAIL YVONNE PICKETT PHD
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56501-3905

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1669413092 — PRESCRIPTION SHOPPE IIOF DETROIT LAKES MN
Practice Location Address:

1245 WASHINGTON AVE
DETROIT LAKES, MN
56501-3905

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Practice Fax: 218-846-2114

Directions to “SANFORD CLINIC NORTH ” Practice Location

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