MEDICARE: CENTRACARE HEALTH SYSTEM - LONG PRAIRIE

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	282NC0060X	Critical Access Hospital	331051	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164471678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRACARE HEALTH SYSTEM - LONG PRAIRIE

Provider Business Mailing Address
First Line	:	1406 6TH AVE N
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1901
Country	:	US
Telephone Number	:	320-251-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 CENTRACARE DR
Second Line	:
City	:	LONG PRAIRIE
State	:	MN
Zip	:	56347-2100
Country	:	US
Telephone Number	:	320-732-2141
Fax Number	:

Authorized Official
Title or Position	:	SR. VICE PRESIDENT AND CFO
Name	:	MR. MICHAEL A. BLAIR
Credential	:
Telephone Number	:	320-255-5665

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	10/10/2019

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