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1406 6th Ave N Saint Cloud MN 56303-1900 | |
| (320) 251-2700 | |
| (320) 255-5711 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 1406 6th Ave N, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Gregory R Klugherz (VICE PRESIDENT AND CFO) |
| Authorized Official Contact | 3202555665 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1406 6th Ave N Saint Cloud MN 56303-1900 Ph: (320) 251-2700 | 1406 6th Ave N Saint Cloud MN 56303-1900 Ph: (320) 251-2700 |
| NPI Number | 1083164255 |
|---|---|
| Provider Enumeration Date | 10/11/2016 |
| Last Update Date | 04/05/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083164255 | NPI | - | NPPES |
| 6900009424 | Other | MN | RR MEDICARE |
| 443985600 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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