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1900 Centracare Circle Centracare Clinic Internal Medicine St Cloud MN 56303 | |
(320) 229-4928 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1900 Centracare Circle, St Cloud, Minnesota |
Authorized Official Name and Position | Michael A Blair (SR VP & CFO) |
Authorized Official Contact | 3202555665 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1200 6th Ave N Saint Cloud MN 56303-2736 Ph: (320) 229-4977 | 1900 Centracare Circle Centracare Clinic Internal Medicine St Cloud MN 56303 Ph: (320) 229-4928 |
NPI Number | 1659425114 |
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Provider Enumeration Date | 01/22/2007 |
Last Update Date | 11/19/2020 |
Medicare PECOS PAC ID | 2466363395 |
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Medicare Enrollment ID | O20100930056075 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659425114 | NPI | - | NPPES |
052720300 | Medicaid | MN | |
990228700 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |