| Organization Name: | CENTRACARE CLINIC |
| NPI Number: | 1043212665 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS M FELDHEGE (TREASURER) |
| Mailing Address: | 1200 Sixth Ave No Centracare Clinic St Cloud |
| State: | MN US |
| Postal Code: | 563032735 |
| Phone Number: | 3202525131 |
| Fax Number: | 3202402118 |
| NPI Enumeration Date: | 08/12/2005 |
| NPI Last Update Date: | 07/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |