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General NPI Number Information
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NPI Number | 1457726549
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Entity Type | Organization
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Legal Business Name | CENTRACARE CLINIC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 30 RAILROAD AVE
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City | ALBANY
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State | MN
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Zip | 56307
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Country | US
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Telephone | 320-845-2157
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 6TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2735
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Country | US
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Telephone | 320-845-2157
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Fax | 320-845-6138
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Authorized Official
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Title or Position | SR VP & CFO
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Name | MICHAEL A BLAIR
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Credential |
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Telephone | 320-255-5665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | MN
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