| Centracare Clinic Internal Medicine | |
|
1900 Centracare Circle Centracare Clinic Internal Medicine St Cloud MN 56303 | |
| (320) 229-4928 | |
| Not Available |
| Full Name | Centracare Clinic Internal Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 1900 Centracare Circle, St Cloud, 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 Clinic Internal Medicine 1200 6th Ave N Saint Cloud MN 56303-2736 Ph: (320) 229-4977 | Centracare Clinic Internal Medicine 1900 Centracare Circle Centracare Clinic Internal Medicine St Cloud MN 56303 Ph: (320) 229-4928 |
| NPI Number | 1659425114 |
|---|---|
| Provider Enumeration Date | 01/22/2007 |
| Last Update Date | 11/19/2020 |
| Medicare PECOS PAC ID | 2466363395 |
|---|---|
| Medicare Enrollment ID | O20100930056075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659425114 | NPI | - | NPPES |
| 052720300 | Medicaid | MN | |
| 990228700 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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