| Organization Name: | ST. CLOUD ST. UNIVERSITY HEALTH SERVICES |
| NPI Number: | 1013993401 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CORITA BECKERMANN (DIRECTOR) |
| Mailing Address: | 720 4th Ave S Saint Cloud |
| State: | MN US |
| Postal Code: | 563014442 |
| Phone Number: | 3203083193 |
| Fax Number: | 3203083192 |
| NPI Enumeration Date: | 12/19/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS1000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Student Health |
| Taxonomy Definition: | |