MEDICARE: CENTRACARE HEALTH-PAYNESVILLE LLC

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
1	261QC0050X	Critical Access Hospital Clinic/Center

General Provider Information

NPI Number	:	1912330663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRACARE HEALTH-PAYNESVILLE LLC

Provider Business Mailing Address
First Line	:	200 W 1ST ST
Second Line	:
City	:	PAYNESVILLE
State	:	MN
Zip	:	56362-1445
Country	:	US
Telephone Number	:	320-243-3767
Fax Number	:	320-243-7955

Provider Business Practice Location Address
First Line	:	308 5TH AVE S
Second Line	:	SUITE 100
City	:	COLD SPRING
State	:	MN
Zip	:	56320-2341
Country	:	US
Telephone Number	:	320-685-7787
Fax Number	:	320-685-7793

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL BLAIR
Credential	:
Telephone Number	:	320-255-5665

Provider Enumeration Date	:	08/16/2013
Last Update Date	:	02/20/2023

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