Sanford Clinic North

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SANFORD CLINIC NORTH

Doing business as

Perham Health Ottertail Clinic

Practice address

105 Otter Drive
Ottertail, MN 56571-7040

Phone

(218) 367-6111

Fax

(218) 367-6110

NPI assigned

Jul 8, 2006

Last updated

Nov 7, 2011By the provider in NPPES

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

VP

Phone

(701) 234-6248

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Perham Health Ottertail Clinic Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Sanford Medical Center Fargo

  dba Sanford Histocompatibility Laboratory

  • Clinical Medical Laboratory
  • Fargo, ND
  • NPI 1164652640

  Member Of

  NPD member

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320624000000",
    "number": "1619900289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 4TH ST N",
            "address_2": "PO BOX 2010",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581220605",
            "telephone_number": "218-367-6111",
            "fax_number": "218-367-6110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 OTTER DRIVE",
            "city": "OTTERTAIL",
            "state": "MN",
            "postal_code": "565717040",
            "telephone_number": "218-367-6111",
            "fax_number": "218-367-6110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANFORD CLINIC NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2011-11-07",
        "status": "A",
        "authorized_official_last_name": "LECLERC",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "701-234-6248"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44100700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Perham Health Ottertail Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David A Bachelder, PA-C
• Julie Domino
• Jessica L Grimes, M.D.
• Perham Hospital District (Perham Health Ottertail Clinic)
• Prescription Home Care LLC
• Seip Drug LLC (Seip Drug #11)
• Southtown Econodrug (Econodrug Ottertail)

• Family Medicine Physician in Ottertail, MN
• Providers in Ottertail, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.