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General NPI Number Information
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NPI Number | 1174556591
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Entity Type | Organization
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Legal Business Name | SANFORD CLINIC NORTH
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 1301 8TH ST S
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City | MOORHEAD
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State | MN
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Zip | 56560-3604
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Country | US
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Telephone | 701-234-3200
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Fax | 701-234-3286
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Provider Business Mailing Address
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Address Line | 1301 8TH ST S
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City | MOORHEAD
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State | MN
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Zip | 56560-3604
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Country | US
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Telephone | 701-234-3200
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Fax | 701-234-3286
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Authorized Official
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Title or Position | VP
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Name | MARTHA K LECLERC
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Credential |
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Telephone | 701-234-6248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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