# CENTRACARE HEALTH - PAYNESVILLE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CentraCare Health - Paynesville Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760440846
- **Authorized official:** MR. MICHAEL A. BLAIR (SR. VICE PRESIDENT AND CFO)
- **Authorized official phone:** (320) 255-5665

## Contact information

- **Practice address:** 200 W 1ST ST, PAYNESVILLE, MN 56362
- **Practice address phone:** (320) 243-3767
- **Practice address fax:** (320) 243-7519
- **Mailing address:** 200 W 1ST ST, PAYNESVILLE, MN 56362-1445
- **Mailing address phone:** (320) 243-3767
- **Mailing address fax:** (320) 243-7519

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/01/2006
- **Last updated:** 10/10/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 03072202705 | HOSP. PRIMEWEST | — |
| 01 | — | 1006079 | HOSP. PREF. ONE | — |
| 01 | — | 10141401 | HOSP. HEALTH PARTNERS | — |
| 01 | — | 1802HPA | HOSP & SWING BED BCBS | — |
| 01 | — | 300173 | HOSP. UCARE | — |
| 05 | — | 333747200 | — | MN |
| 01 | — | 5003780 | HOSP. MEDICA | — |