| |
1555 Northway Drive St Cloud MN 56303 | |
(320) 251-1775 | |
(320) 240-3131 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1555 Northway Drive, 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 |
---|---|
1200 6th Ave N Saint Cloud MN 56303-2736 Ph: (320) 229-4977 | 1555 Northway Drive St Cloud MN 56303 Ph: (320) 251-1775 |
NPI Number | 1881696490 |
---|---|
Provider Enumeration Date | 08/12/2005 |
Last Update Date | 11/19/2020 |
Medicare PECOS PAC ID | 2466363395 |
---|---|
Medicare Enrollment ID | O20100930029718 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881696490 | NPI | - | NPPES |
NA131 | Other | PREF ONE | |
86D71CE | Other | BCBS | |
35580 | Other | HEALTH PARTNERS | |
98-01806 | Other | MEDICA | |
110963 | Other | UCARE | |
990228700 | Medicaid | MN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |