Healthcare Provider Details

I. General information

NPI: 1487928743
Provider Name (Legal Business Name): CENTRACARE HEALTH SYSTEM - SAUK CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ELM ST N
SAUK CENTRE MN
56378-1010
US

IV. Provider business mailing address

1406 6TH AVE N
SAINT CLOUD MN
56303-1900
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 Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
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