MEDICARE: CENTRACARE HEALTH - PAYNESVILLE LLC

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	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	300173	OTHER	HOSP. UCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5003780	OTHER	HOSP. MEDICA
4	10141401	OTHER	HOSP. HEALTH PARTNERS
5	03072202705	OTHER	HOSP. PRIMEWEST
6	1006079	OTHER	HOSP. PREF. ONE
7	1802HPA	OTHER	HOSP & SWING BED BCBS

General Provider Information

NPI Number	:	1760440846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRACARE HEALTH - PAYNESVILLE LLC

Provider Business Mailing Address
First Line	:	200 W 1ST ST
Second Line	:
City	:	PAYNESVILLE
State	:	MN
Zip	:	56362-1445
Country	:	US
Telephone Number	:	320-243-3767
Fax Number	:	320-243-7519

Provider Business Practice Location Address
First Line	:	200 W 1ST ST
Second Line	:
City	:	PAYNESVILLE
State	:	MN
Zip	:	56362
Country	:	US
Telephone Number	:	320-243-3767
Fax Number	:	320-243-7519

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	10/10/2019

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Directions to “CENTRACARE HEALTH - PAYNESVILLE LLC ” Practice Location

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