# CENTRACARE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CentraCare Clinic - Lifestyle Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770020489
- **Authorized official:** THOMAS M FELDHEGE (DIRECTOR OF FINANCE AND TREASURER)
- **Authorized official phone:** (320) 240-2152

## Contact information

- **Practice address:** 2001 STOCKINGER DRIVE, SUITE 101, ST CLOUD, MN 56303
- **Practice address phone:** (320) 251-2700
- **Practice address fax:** (320) 656-7009
- **Mailing address:** 1200 6TH AVE N, SAINT CLOUD, MN 56303-2735
- **Mailing address phone:** (320) 252-5131
- **Mailing address fax:** (320) 240-2118

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | MN | Yes |

## Other

- **Enumeration date:** 01/20/2017
- **Last updated:** 05/11/2017