MEDICARE: ST CLOUD HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		MN

General Provider Information

NPI Number	:	1043757404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CLOUD HOSPITAL

Provider Business Mailing Address
First Line	:	1406 6TH AVE N
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1900
Country	:	US
Telephone Number	:	320-251-2700
Fax Number	:	320-656-7009

Provider Business Practice Location Address
First Line	:	30 25TH AVE S
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-6285
Country	:	US
Telephone Number	:	320-251-2700
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT AND CFO
Name	:	GREGORY R KLUGHERZ
Credential	:
Telephone Number	:	320-255-5665

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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Directions to “ST CLOUD HOSPITAL ” Practice Location

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