Sanford Clinic North

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

DEA#:35D0655616 Issued in ND

Legal business name

SANFORD CLINIC NORTH

Doing business as

Sanford Broadway Clinic- Laboratory

Practice address

737 Broadway
Fargo, ND 58122-0040

Phone

(701) 280-4150

Fax

(701) 234-2045

NPI assigned

Dec 29, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Martha K Leclerc

Title

Vice President

Phone

(701) 234-6248

Specialties & licenses 2

Addresses

Other names 1

• Sanford Broadway Clinic- Laboratory Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Meritcare Medical Group

  dba MeritCare LaMoure

  • Family Medicine Physician
  • Lamoure, ND
  • NPI 1134141153

  O20040202000680

  Same enrollment
• Sanford Clinic North

  dba Sanford South University Laboratory

  • Clinical Medical Laboratory
  • St Augustine, FL
  • NPI 1174680052

  O20040202000680

  Same enrollment

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1225194574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 BROADWAY",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581220040",
            "telephone_number": "701-280-4150",
            "fax_number": "701-234-2045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 BROADWAY",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581220040",
            "telephone_number": "701-280-4150",
            "fax_number": "701-234-2045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1133 Overdale Rd",
            "address_purpose": "LOCATION",
            "city": "St Augustine",
            "state": "FL",
            "postal_code": "320802302",
            "country_code": "US",
            "telephone_number": "701-417-7300",
            "fax_number": "701-234-7378",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANFORD CLINIC NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "LECLERC",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "701-234-6248"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ND",
            "license": "DEA#:35D0655616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sanford Broadway Clinic- Laboratory",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sanford Broadway Clinic- Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sanford Clinic North (Sanford Children's Southwest Clinic)
• Sanford Clinic North (Sanford Pharmacy Broadway 340B)
• Sanford Clinic North (Sanford Professional Building)
• Sanford Clinic North (Sanford Roger Maris Cancer Center)
• Sanford Clinic North (Sanford North Fargo Clinic)
• Sanford Clinic North (Sanford Health Edgewood Vista Clinic)
• Sanford Clinic North (Sanford Broadway Medical Building)
• Sanford Clinic North (Sanford South University)
• Sanford Clinic North (Sanford Reproductive Medicine Clinic)
• Sanford Clinic North (Sanford Mobile Radiology)

• Clinical Medical Laboratory in Fargo, ND
• Providers in Fargo, ND by specialty
• Clinical Medical Laboratory in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.