# CENTRACARE CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1790201739
- **Authorized official:** MICHAEL A BLAIR (SR VP & CFO)
- **Authorized official phone:** (320) 255-5665

## Contact information

- **Practice address:** 3701 12TH ST N STE 202, SAINT CLOUD, MN 56303-2253
- **Practice address phone:** (320) 258-3090
- **Mailing address:** PO BOX 735818, CHICAGO, IL 60673-5818
- **Mailing address phone:** (320) 251-2700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/22/2017
- **Last updated:** 09/14/2026