Healthcare Provider Details

I. General information

NPI: 1922337344
Provider Name (Legal Business Name): CENTRAL MINNESOTA GROUP HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 ROOSEVELT RD DISTRICT SQUARE SUITE 140
SAINT CLOUD MN
56301-4867
US

IV. Provider business mailing address

1245 15TH ST N
SAINT CLOUD MN
56303-1802
US

V. Phone/Fax

Practice location:
  • Phone: 320-203-2380
  • Fax: 320-203-2381
Mailing address:
  • Phone: 320-253-5220
  • Fax: 320-203-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateMN

VIII. Authorized Official

Name: ANDREW J. VINSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 320-203-2020