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General NPI Number Information
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NPI Number | 1497986582
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Entity Type | Organization
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Legal Business Name | CENTRACARE HEALTH SYSTEM - LONG PRAIRIE
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 50 CENTRACARE DR
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City | LONG PRAIRIE
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State | MN
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Zip | 56347-2100
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Country | US
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Telephone | 320-732-2141
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Fax | 320-732-3802
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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 | 320-732-2141
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Fax | 320-732-3802
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Authorized Official
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Title or Position | SR. VICE PRESIDENT AND CFO
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Name | MR. 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 342848
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License Number State | MN
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