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	411086657	MN
2	261QU0200X	Urgent Care Clinic/Center
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	498R1CE	OTHER	BCBS
2	170317	OTHER	UCARE
3	35580	OTHER	HEALTH PARTNERS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	NA356	OTHER	PREF ONE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	98-00211	OTHER	MEDICA

General Provider Information

NPI Number	:	1407858020
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	:

Provider Business Practice Location Address
First Line	:	1900 CENTRACARE CIR
Second Line	:	CENTRACARE CLINIC HEALTH PLAZA
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-5000
Country	:	US
Telephone Number	:	320-252-2422
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	11/19/2020

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Directions to “CENTRACARE CLINIC ” Practice Location

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