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NPI Code Detail

MEDICARE: CENTRACARE CLINIC

MEDICARE: CENTRACARE CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
2261QM1300XMulti-Specialty Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NA131OTHERPREF ONE
298-01806OTHERMEDICA
3110963OTHERUCARE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
586D71CEOTHERBCBS
635580OTHERHEALTH PARTNERS

General Provider Information

NPI Number : 1881696490
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRACARE CLINIC
Provider Business Mailing Address
First Line : 1200 6TH AVE N
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-2736
Country : US
Telephone Number : 320-229-4977
Fax Number : 320-240-3131
Provider Business Practice Location Address
First Line : 1555 NORTHWAY DR STE 100
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-1258
Country : US
Telephone Number : 320-251-1775
Fax Number : 320-240-3131
Authorized Official
Title or Position : SR VP & CFO
Name : MICHAEL A BLAIR
Credential :
Telephone Number : 320-255-5665
Provider Enumeration Date : 08/12/2005
Last Update Date : 06/23/2025

Similar Medicare Providers

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Practice Location Address:
1555 NORTHWAY DR STE 100
SAINT CLOUD, MN
56303-1258
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1265524136 — MRS. GINA MARIE WIPPLER PA-C
Practice Location Address:
1555 NORTHWAY DRIVE #100 , CENTRACARE CLINIC NORTHWAY FAMILY MEDICINE
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1427589530 — NICOLE MEIER CNP
Practice Location Address:
1555 NORTHWAY DR STE 100
SAINT CLOUD, MN
56303-1258
Practice Phone: 320-240-1775
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1093221400 — MRS. KAYLA FERRIE MSW, LICSW
Practice Location Address:
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1649758145 — KAYLA ASH
Practice Location Address:
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Practice Fax:
1407499023 — BERNADETTE T WARNERT CNP
Practice Location Address:
1555 NORTHWAY DR STE 100
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Practice Phone: 657-203-1295
Practice Fax:

Directions to “CENTRACARE CLINIC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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