CENTRACARE CLINIC NPI 1710048590

NPI Information

NPI: 1710048590
Provider Name: CENTRACARE CLINIC

Doing Business As: CENTRACARE - BECKER CLINIC

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
12800 ROLLING RIDGE
CENTRACARE CLINIC BECKER
BECKER, MN
ZIP 55308
Phone: (763) 261-7000
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CENTRACARE CLINIC is a multi-specialty clinic center in Becker, MN. CENTRACARE CLINIC NPI is 1710048590. The provider is registered as an organization entity type.
The provider Is Doing Business As Centracare - Becker Clinic.

The provider's business location address is:

12800 ROLLING RIDGE
CENTRACARE CLINIC BECKER
BECKER, MN
ZIP 55308
Phone: (763) 261-7000

The provider's authorized official is Michael A Blair .
The authorized official title is Sr Vp & Cfo and has the following contact phone number (320) 255-5665.

The CLIA number assigned to this NPI record is 24D0927853 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 12/13/2006 and was last updated on 11/19/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty			Yes
2	332B00000X	Durable Medical Equipment & Medical Supplies				No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	NA197	OTHER		PREF ONE
2	35580	OTHER		HEALTH PARTNERS
3	990228700	MEDICAID	MINNESOTA
4	120173	OTHER		UCARE
5	86D71CE	OTHER		BCBS
6	98-00379	OTHER		MEDICA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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