Organization
CENTRACARE CLINIC
Active
Parent organization
CENTRACARE CLINIC
Other names
CentraCare - Plaza 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
1900 CENTRACARE CIR, CENTRACARE CLINIC HEALTH PLAZA, SAINT CLOUD, MN 56303-5000
(320) 252-2422
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
411086657
MN
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052720300
—
MN
05
—
052720303
—
MN
01
—
170317
UCARE
—
01
—
35580
HEALTH PARTNERS
—
01
—
498R1CE
BCBS
—
01
—
98-00211
MEDICA
—
01
—
NA356
PREF ONE
—
Enumeration date
08/12/2005
Last updated
11/19/2020
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