Healthcare Provider Details

I. General information

NPI: 1740677509
Provider Name (Legal Business Name): CENTRACARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 HIGHWAY 23
FOLEY MN
56329-9145
US

IV. Provider business mailing address

471 HIGHWAY 23 P.O. BOX 218
FOLEY MN
56329-9145
US

V. Phone/Fax

Practice location:
  • Phone: 320-968-7234
  • Fax:
Mailing address:
  • Phone: 320-968-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS M FELDHEGE
Title or Position: CFO/TREASURER
Credential:
Phone: 320-240-2152