| Organization Name: | SANFORD MEDICAL CENTER FARGO |
| NPI Number: | 1053557884 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARTHA K LECLERC (VP) |
| Mailing Address: | 120 Labree Ave S Thief River Falls |
| State: | MN US |
| Postal Code: | 567012840 |
| Phone Number: | 2186814240 |
| Fax Number: | |
| NPI Enumeration Date: | 12/29/2008 |
| NPI Last Update Date: | 11/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |