| Sanford Clinic North | |
|
21 Wiley Avenue South Lidgerwood ND 58053-4001 | |
| (701) 538-4189 | |
| (701) 538-4319 |
| Full Name | Sanford Clinic North |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 21 Wiley Avenue South, Lidgerwood, North Dakota |
| Authorized Official Name and Position | Martha K Leclerc (VP) |
| Authorized Official Contact | 7012346248 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sanford Clinic North 720 Fourth Street S Fargo ND 58122-0605 Ph: (701) 234-2000 | Sanford Clinic North 21 Wiley Avenue South Lidgerwood ND 58053-4001 Ph: (701) 538-4189 |
| NPI Number | 1255348280 |
|---|---|
| Provider Enumeration Date | 08/02/2006 |
| Last Update Date | 11/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255348280 | NPI | - | NPPES |
| 12857 | Medicaid | ND | |
| CF8850 | Other | ND | RAILROAD MEDICARE |
| 1327001 | Other | ND | BLUE SHIELD |
| 5135 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |