Healthcare Provider Details

I. General information

NPI: 1972520773
Provider Name (Legal Business Name): CENTRAL MINNESOTA NEUROSCIENCES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 6TH AVE N
ST. CLOUD MN
56303
US

IV. Provider business mailing address

PO BOX 340
SAINT CLOUD MN
56302-0340
US

V. Phone/Fax

Practice location:
  • Phone: 320-255-5622
  • Fax: 320-259-5896
Mailing address:
  • Phone: 320-258-8456
  • Fax: 320-259-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET HALLERMANN
Title or Position: ADMINISTRATOR
Credential:
Phone: 320-251-2700