Healthcare Provider Details

I. General information

NPI: 1679088157
Provider Name (Legal Business Name): ST. CLOUD HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 33RD ST S STE 210
SAINT CLOUD MN
56301-9668
US

IV. Provider business mailing address

1406 6TH AVE N
SAINT CLOUD MN
56303-1900
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-2700
  • Fax: 320-656-7009
Mailing address:
  • Phone: 320-251-2700
  • Fax: 320-656-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL A. BLAIR
Title or Position: SR. VICE PRESIDENT & CFO
Credential:
Phone: 320-255-5665