MEDICARE: SANFORD CLINIC NORTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1306118039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANFORD CLINIC NORTH

Provider Business Mailing Address
First Line	:	115 E SOO ST
Second Line	:
City	:	PARKERS PRAIRIE
State	:	MN
Zip	:	56361-4995
Country	:	US
Telephone Number	:	218-338-4371
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E SOO ST
Second Line	:
City	:	PARKERS PRAIRIE
State	:	MN
Zip	:	56361-4995
Country	:	US
Telephone Number	:	218-338-4371
Fax Number	:

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

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	11/27/2023

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Directions to “SANFORD CLINIC NORTH ” Practice Location

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