Healthcare Provider Details

I. General information

NPI: 1598236408
Provider Name (Legal Business Name): CARRIS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 09/10/2024
Certification Date: 02/02/2021
Deactivation Date: 06/04/2024
Reactivation Date: 09/10/2024

III. Provider practice location address

101 WILLMAR AVE SW
WILLMAR MN
56201-3556
US

IV. Provider business mailing address

301 BECKER AVE SW
WILLMAR MN
56201-3302
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-5000
  • Fax:
Mailing address:
  • Phone: 320-231-4715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BLAIR
Title or Position: CFO
Credential:
Phone: 320-255-5665