Organization

Sanford Medical Center Fargo

May also be knows as Sanford Health Edgewood Vista Clinic

Geriatric Medicine (Internal Medicine) Physician in Fargo, ND(View on Map)

Legal Business Name

Sanford Medical Center Fargo

Also Known As

Sanford Health Edgewood Vista Clinic

NPI Number

1548540826

NPI Type

Organization

Enumeration Date

08/18/2011

Specialties

(Taxonomies)

Code

207RG0300X

Primary Taxonomy

Yes

Contact
Information

Purpose

Mailing
Location

Address

4420 37TH AVE S
4420 37TH AVE S

City

Fargo
Fargo

State

ND
ND

Postal Code

58104-3400
58104-3400

Country

US
US

Telephone Number

(701) 365-4746
(701) 365-4746

Authorized Official

Name

Martha Leclerc

Title or Position

VICE PRESIDENT

Telephone Number

(701) 234-6248

Health Information Exchange

Endpoint Type

CONNECT

Endpoint

https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service

Endpoint Description

2.16.840.1.113883.3.1068.1

Use

Other

Content Type

Unknown

Affiliation

Y

Endpoint Location

2720 Dundee Rd # 302Northbrook, IL600622609US

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 11/25/2019

Provider Address