Organization
CENTRACARE CLINIC
Active
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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