Organization
ST. CLOUD HOSPITAL
Active
Parent organization
ST CLOUD HOSPITAL
Other names
Centra Care Family Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST CLOUD HOSPITAL
Authorized official
MR. MICHAEL A. BLAIR (SR. VICE PRESIDENT AND CFO)
(320) 255-5665
Entity
Organization
Contact information
Practice address
1555 NORTHWAY DRIVE, SUITE 200, ST CLOUD, MN 56303-4913
(320) 240-3157
(320) 240-3143
Mailing address
1555 NORTHWAY DRIVE, SUITE 200, ST CLOUD, MN 56303-4913
(320) 240-3157
(320) 240-3143
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
331506
MN
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
616053100
—
MN
01
—
690000070
CENTRACARE LAB
MN
01
—
RR MEDICARE
690009424
MN
Enumeration date
05/09/2006
Last updated
10/10/2019
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