| Centracare - Big Lake Clinic | |
|
16830 198th Ave Nw Centracare Clinic - Big Lake Big Lake MN 55309-4860 | |
| (763) 263-7300 | |
| (763) 263-7338 |
| Full Name | Centracare - Big Lake Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 16830 198th Ave Nw, Big Lake, Minnesota |
| Authorized Official Name and Position | Michael A Blair (SR VP & CFO) |
| Authorized Official Contact | 3202555665 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centracare - Big Lake Clinic 1200 6th Ave N Saint Cloud MN 56303-2736 Ph: (320) 229-4977 | Centracare - Big Lake Clinic 16830 198th Ave Nw Centracare Clinic - Big Lake Big Lake MN 55309-4860 Ph: (763) 263-7300 |
| NPI Number | 1013104348 |
|---|---|
| Provider Enumeration Date | 10/01/2007 |
| Last Update Date | 11/19/2020 |
| Medicare PECOS PAC ID | 2466363395 |
|---|---|
| Medicare Enrollment ID | O20141010001588 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013104348 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |