Healthcare Provider Details

I. General information

NPI: 1043269798
Provider Name (Legal Business Name): ST. CLOUD HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 320-307-3676
  • Fax: 320-656-7009
Mailing address:
  • Phone: 320-307-3676
  • Fax: 320-656-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number331506
License Number StateMN

VIII. Authorized Official

Name: MR. MICHAEL A. BLAIR
Title or Position: SR. VICE PRESIDENT & CFO
Credential:
Phone: 320-307-3676