| Organization Name: | CENTRACARE CLINIC |
| NPI Number: | 1134121759 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS M FELDHEGE (TREASURER, DIRECTOR OF FINANCE) |
| Mailing Address: | 1360 Elm Street East Centracare Clinic - St Joseph St Joseph |
| State: | MN US |
| Postal Code: | 563744106 |
| Phone Number: | 3203637765 |
| Fax Number: | |
| NPI Enumeration Date: | 08/12/2005 |
| NPI Last Update Date: | 12/16/2013 |
| 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: | |