MEDICARE: CENTRACARE HEALTH SYSTEM

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician
2	341600000X	Ambulance

General Provider Information

NPI Number	:	1457901506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRACARE HEALTH SYSTEM

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	:

Provider Business Practice Location Address
First Line	:	121 LAKE ST N
Second Line	:
City	:	BIG LAKE
State	:	MN
Zip	:	55309-9254
Country	:	US
Telephone Number	:	320-251-2700
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MICHAEL BLAIR
Credential	:
Telephone Number	:	320-251-2700

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	04/16/2024

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Directions to “CENTRACARE HEALTH SYSTEM ” Practice Location

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