Organization
ST. CLOUD HOSPITAL
Active
Other names
CentraCare Kidney Program - Brainerd Dialysis
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
2024 SO 6TH ST, BRAINERD, MN 56401
(218) 825-8964
(320) 656-7009
Mailing address
1406 6TH AVE NORTH, SAINT CLOUD, MN 56303-1900
(320) 251-2700
(320) 656-7009
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
331506
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
883747300
—
MN
Enumeration date
05/10/2006
Last updated
09/10/2024
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