Healthcare Provider Details

I. General information

NPI: 1912330663
Provider Name (Legal Business Name): CENTRACARE HEALTH-PAYNESVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 5TH AVE S SUITE 100
COLD SPRING MN
56320-2341
US

IV. Provider business mailing address

200 W 1ST ST
PAYNESVILLE MN
56362-1445
US

V. Phone/Fax

Practice location:
  • Phone: 320-685-7787
  • Fax: 320-685-7793
Mailing address:
  • Phone: 320-243-3767
  • Fax: 320-243-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BLAIR
Title or Position: CFO
Credential:
Phone: 320-255-5665