| Centra Care Family Health Center | |
|
1555 Northway Drive Suite 200 St Cloud MN 56303-4913 | |
| (320) 240-3157 | |
| (320) 240-3143 |
| Full Name | Centra Care Family Health Center |
|---|---|
| Speciality | Clinic/center |
| Location | 1555 Northway Drive, St Cloud, Minnesota |
| Authorized Official Name and Position | Michael A. Blair (SR. VICE PRESIDENT AND CFO) |
| Authorized Official Contact | 3202555665 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centra Care Family Health Center 1555 Northway Drive Suite 200 St Cloud MN 56303-4913 Ph: (320) 240-3157 | Centra Care Family Health Center 1555 Northway Drive Suite 200 St Cloud MN 56303-4913 Ph: (320) 240-3157 |
| NPI Number | 1770532426 |
|---|---|
| Provider Enumeration Date | 05/09/2006 |
| Last Update Date | 10/10/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770532426 | NPI | - | NPPES |
| 616053100 | Medicaid | MN | |
| 690000070 | Other | MN | CENTRACARE LAB |
| RR MEDICARE | Other | MN | 690009424 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 331506 (Minnesota) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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