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General NPI Number Information
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NPI Number | 1427077361
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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 | 07/19/2006
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 253 CENTRAL AVE N
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City | VALLEY CITY
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State | ND
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Zip | 58072-2941
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Country | US
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Telephone | 701-845-1511
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Fax | 701-845-1513
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Provider Business Mailing Address
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Address Line | 253 CENTRAL AVE N
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City | VALLEY CITY
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State | ND
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Zip | 58072-2941
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Country | US
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Telephone | 701-845-1511
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Fax | 701-845-1513
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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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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