Healthcare Provider Details

I. General information

NPI: 1629070230
Provider Name (Legal Business Name): CENTRACARE CLINIC MELROSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W MAIN ST
MELROSE MN
56352
US

IV. Provider business mailing address

525 W MAIN ST
MELROSE MN
56352
US

V. Phone/Fax

Practice location:
  • Phone: 320-256-4228
  • Fax: 320-256-7106
Mailing address:
  • Phone: 320-256-4228
  • Fax: 320-256-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: THOMAS M FELDHEGE
Title or Position: TREASURER DIRECTOR OF FINANCE
Credential:
Phone: 320-240-2152