Organization
INTEGRACARE LTD
Active
Other names
Williams/Integracare Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK RANDY HALSTROM MD (MEDICAL DIRECTOR)
(320) 251-2600
Entity
Organization
Contact information
Practice address
100 SOUTH 2ND STREET, SARTELL, MN 56377
(320) 251-2600
(320) 251-4763
Mailing address
100 SOUTH 2ND STREET, SARTELL, MN 56377
(320) 251-2600
(320) 251-4763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1491
MN
225100000X
Physical Therapist
1491
MN
363L00000X
Nurse Practitioner
1491
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079858400
—
MN
01
—
1219767
ARAZ
MN
01
—
169318P539
UCARE
MN
01
—
1770646937
HUMANA
MN
01
—
31T18IN
CCS
MN
01
—
9823046
MEDICA
MN
01
—
CH3371
RAILROAD MEDICARE
MN
Enumeration date
08/10/2010
Last updated
01/24/2019
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