Organization
CENTRACARE HEALTH - PAYNESVILLE LLC
Active
Other names
CentraCare Health - Paynesville Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A. BLAIR (SR. VICE PRESIDENT AND CFO)
(320) 255-5665
Entity
Organization
Contact information
Practice address
200 W 1ST ST, PAYNESVILLE, MN 56362
(320) 243-3767
(320) 243-7519
Mailing address
200 W 1ST ST, PAYNESVILLE, MN 56362-1445
(320) 243-3767
(320) 243-7519
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03072202705
HOSP. PRIMEWEST
—
01
—
1006079
HOSP. PREF. ONE
—
01
—
10141401
HOSP. HEALTH PARTNERS
—
01
—
1802HPA
HOSP & SWING BED BCBS
—
01
—
300173
HOSP. UCARE
—
05
—
333747200
—
MN
01
—
5003780
HOSP. MEDICA
—
Enumeration date
05/01/2006
Last updated
10/10/2019
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