| Sanford Children's Southwest Clinic | |
|
2701 13th Ave S Fargo ND 58103-3602 | |
| (701) 234-3600 | |
| (701) 234-3528 |
| Full Name | Sanford Children's Southwest Clinic |
|---|---|
| Speciality | Pediatrics |
| Location | 2701 13th Ave S, Fargo, 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 Children's Southwest Clinic 2701 13th Ave S Fargo ND 58103-3602 Ph: (701) 234-3600 | Sanford Children's Southwest Clinic 2701 13th Ave S Fargo ND 58103-3602 Ph: (701) 234-3600 |
| NPI Number | 1033147046 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 11/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033147046 | NPI | - | NPPES |
| 086712800 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
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