Organization
CENTRACARE CLINIC
Active
Other names
CentraCare - Midsota Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL A BLAIR (SR VP & CFO)
(320) 255-5665
Entity
Organization
Contact information
Practice address
3701 12TH ST N, SUITE 100, SAINT CLOUD, MN 56303-2255
(320) 253-7257
(320) 251-2938
Mailing address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2735
(320) 252-5131
(320) 240-2118
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110890
UCARE
MN
01
—
35580
HEALTH PARTNERS
MN
01
—
6D053CE
BLUE CROSS BLUE SHIELD
MN
01
—
98-04122
MEDICA
MN
01
—
990228700
MEDICAID
MN
01
—
N002912
CHAMPUS
MN
Enumeration date
08/29/2016
Last updated
06/23/2025
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