| Organization Name: | CENTRACARE CLINIC |
| NPI Number: | 1013104348 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS M FELDHEGE (TREAS/DIR OF FINANCE) |
| Mailing Address: | 16830 198th Ave Nw Centracare Clinic - Big Lake Big Lake |
| State: | MN US |
| Postal Code: | 553094860 |
| Phone Number: | 7632637300 |
| Fax Number: | 7632637338 |
| NPI Enumeration Date: | 10/01/2007 |
| NPI Last Update Date: | 07/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |