CENTRACARE CLINIC NPI 1164978219

NPI Information

  • NPI: 1164978219
  • Provider Name: CENTRACARE CLINIC
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • :
  • Address: 3701 12TH ST N
    SUITE 100
    SAINT CLOUD, MN
    ZIP 56303
  • Phone: (320) 253-7257

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NPI Details

CENTRACARE CLINIC is a clinic center in Saint Cloud, MN. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). CENTRACARE CLINIC NPI is 1164978219. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

3701 12TH ST N
SUITE 100
SAINT CLOUD, MN
ZIP 56303-255
Phone: (320) 253-7257
Fax: (320) 251-2938

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 enumeration date for this NPI number is 8/29/2016 and was last updated on 6/23/2025.

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
1261Q00000XClinic/CenterMINNESOTAYes

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
16D053CEOTHERMINNESOTABLUE CROSS BLUE SHIELD
298-04122OTHERMINNESOTAMEDICA
3N002912OTHERMINNESOTACHAMPUS
4990228700OTHERMINNESOTAMEDICAID
5110890OTHERMINNESOTAUCARE
635580OTHERMINNESOTAHEALTH PARTNERS

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: 11/21/2025

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