Organization Name: | SANFORD HEALTH OF NORTHERN MINNESOTA |
NPI Number: | 1093876922 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARTHA K LECLERC (VP) |
Mailing Address: | 1233 34th St Nw Bemidji |
State: | MN US |
Postal Code: | 566015112 |
Phone Number: | 2183335000 |
Fax Number: | 7012342045 |
NPI Enumeration Date: | 12/13/2006 |
NPI Last Update Date: | 11/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |