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1225030844

NPI Code Detail

MEDICARE: CENTRACARE CLINIC

MEDICARE: CENTRACARE CLINIC

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	261QM1300X	Multi-Specialty Clinic/Center		MN
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	261QM1300X	Multi-Specialty Clinic/Center

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
2	NA139	OTHER		PREF ONE
3	35580	OTHER		HEALTH PARTNERS
4	110382	OTHER		UCARE
5	98-12146	OTHER		MEDICA
6	50A45CE	OTHER		BCBS
7	50A61CE	OTHER		BCBS

General Provider Information

NPI Number	:	1225030844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRACARE CLINIC

Provider Business Mailing Address
First Line	:	1200 6TH AVE N
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-2736
Country	:	US
Telephone Number	:	320-229-4977
Fax Number	:	320-654-3667

Provider Business Practice Location Address
First Line	:	1900 CENTRACARE CIR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-5000
Country	:	US
Telephone Number	:	320-654-3630
Fax Number	:	320-654-3667

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	03/31/2026

Similar Medicare Providers

1407858020 — CENTRACARE CLINIC
Practice Location Address:

1900 CENTRACARE CIR , CENTRACARE CLINIC HEALTH PLAZA
SAINT CLOUD, MN
56303-5000

Practice Phone: 320-252-2422
Practice Fax:

1487644134 — JEANNE M NOTSCH CNP
Practice Location Address:

1900 CENTRACARE CIR
SAINT CLOUD, MN
56303-5000

Practice Phone: 320-229-4917
Practice Fax: 320-229-5181

1992795652 — DOUGLAS J WATKINS M.D.
Practice Location Address:

1900 CENTRACARE CIR
SAINT CLOUD, MN
56303-5000

Practice Phone: 320-229-4917
Practice Fax: 320-229-5181

1366432015 — KATHRYN A MECHELKE MD
Practice Location Address:

1900 CENTRACARE CIR
SAINT CLOUD, MN
56303-5000

Practice Phone: 320-229-4917
Practice Fax: 320-229-5181

1982694659 — PAUL J DORSHER MD
Practice Location Address:

1900 CENTRACARE CIR
SAINT CLOUD, MN
56303-5000

Practice Phone: 320-240-2205
Practice Fax: 320-229-5174

1679563274 — PETER E NELSON MD
Practice Location Address:

1900 CENTRACARE CIR
SAINT CLOUD, MN
56303-5000

Practice Phone: 320-240-2205
Practice Fax: 320-229-5174

Directions to “CENTRACARE CLINIC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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