Organization
CENTRACARE CLINIC
Active
Parent organization
CENTRACARE CLINIC
Other names
CentraCare - St. Joseph Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRACARE CLINIC
Authorized official
MR. MICHAEL A BLAIR (SR VP & CFO)
(320) 255-5665
Entity
Organization
Contact information
Practice address
1360 ELM STREET EAST, CENTRACARE CLINIC - ST JOSEPH, ST JOSEPH, MN 56374-4106
(320) 363-7765
Mailing address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2736
(320) 229-4977
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
MN
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110964
UCARE
—
01
—
35580
HEALTH PARTNERS
—
01
—
86D71CE
BCBS
—
01
—
98-01789
MEDICA
—
05
—
990228700
—
MN
01
—
NA133
PREF ONE
—
01
—
NA930
PREF ONE
MN
Enumeration date
08/12/2005
Last updated
06/23/2025
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