Organization
CENTRACARE CLINIC
Active
Organization
CENTRACARE CLINIC
Active
Parent organization
CENTRACARE CLINIC
Other names
CentraCare - Big Lake Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRACARE CLINIC
Authorized official
MICHAEL A BLAIR (SR VP & CFO)
(320) 255-5665
Entity
Organization
Contact information
Practice address
16830 198TH AVE NW, CENTRACARE CLINIC - BIG LAKE, BIG LAKE, MN 55309-4860
(763) 263-7300
(763) 263-7338
Mailing address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2736
(320) 229-4977
(763) 263-7338
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
10/01/2007
Last updated
11/19/2020
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