| Centracare Clinic - Northway Family Medicine | |
|
1555 Northway Drive St Cloud MN 56303 | |
| (320) 251-1775 | |
| (320) 240-3131 |
| Full Name | Centracare Clinic - Northway Family Medicine |
|---|---|
| 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 |
|---|---|
| Centracare Clinic - Northway Family Medicine 1200 6th Ave N Saint Cloud MN 56303-2736 Ph: (320) 229-4977 | Centracare Clinic - Northway Family Medicine 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 |
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