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Organization
CENTRACARE CLINIC
Active
Organization
CENTRACARE CLINIC
Active
Other names
CentraCare - Plaza Clinic (Internal Medicine)
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL A BLAIR (SR VP & CFO)
(320) 255-5665
Entity
Organization
Contact information
Practice address
1900 CENTRACARE CIRCLE, CENTRACARE CLINIC INTERNAL MEDICINE, ST CLOUD, MN 56303
(320) 229-4928
Mailing address
PO BOX 735818, CHICAGO, IL 60673-5818
(320) 229-4977
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052720300
—
MN
05
—
990228700
—
MN
Enumeration date
01/22/2007
Last updated
09/17/2026
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