Healthcare Provider Details

I. General information

NPI: 1578813762
Provider Name (Legal Business Name): CENTRACARE HEALTH SYSTEM - SAUK CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date: 01/25/2023
Reactivation Date: 01/30/2023

III. Provider practice location address

425 ELM ST N
SAUK CENTRE MN
56378-1010
US

IV. Provider business mailing address

1200 6TH AVE N
SAINT CLOUD MN
56303-2735
US

V. Phone/Fax

Practice location:
  • Phone: 320-352-2221
  • Fax: 320-352-5150
Mailing address:
  • Phone: 320-352-2221
  • Fax: 320-352-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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