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Organization

CENTRACARE CLINIC

Active
Parent organization
CENTRACARE CLINIC
Other names
CentraCare - River Campus 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
1200 SIXTH AVE NO, CENTRACARE CLINIC, ST CLOUD, MN 56303-2735
(320) 252-5131
(320) 650-1777
Mailing address
1200 SIXTH AVE NO, CENTRACARE CLINIC, ST CLOUD, MN 56303-2735
(320) 252-5131
(320) 650-1777

Taxonomy

Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
332B00000X
Durable Medical Equipment & Medical Supplies

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110890
U CARE
01
35580
HEALTH PARTNERS
01
6D053CE
BLUE CROSS BLUE SHIELD
01
9804122
MEDICA
MN
05
990228700
MN
01
N002912
CHAMPUS
Enumeration date
08/12/2005
Last updated
04/06/2026
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