| St Cloud Medical Group Pa | |
|
251 County Road 120 Saint Cloud MN 56303-4872 | |
| (320) 202-8949 | |
| (320) 202-0756 |
| Full Name | St Cloud Medical Group Pa |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 251 County Road 120, Saint Cloud, Minnesota |
| Authorized Official Name and Position | Christopher Tacl (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3202028949 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Cloud Medical Group Pa 251 County Road 120 Saint Cloud MN 56303-4872 Ph: (320) 202-8949 | St Cloud Medical Group Pa 251 County Road 120 Saint Cloud MN 56303-4872 Ph: (320) 202-8949 |
| NPI Number | 1487690996 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 10/06/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487690996 | NPI | - | NPPES |
| 175710500 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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