Centracare Clinic - Northway Family Medicine
LBN: Centracare Clinic
Centracare Clinic - Northway Family Medicine is an health care organization with primary practice located at 1555 Northway Drive , St Cloud MN 56303. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Multi-Specialty, Suppliers / Durable Medical Equipment & Medical Supplies. Ambulatory Health Care Facilities / Multi-Specialty is the primary health care specialty.
Centracare Clinic can be contacted via phone (320) 251-1775, or through Blair, Michael A via phone (320) 255-5665.
Contact Information
Primary practice address
1555 Northway Drive
St Cloud MN 56303
Phone: (320) 251-1775
Fax: (320) 240-3131
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Multi-Specialty | 261QM1300X | ||
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X |
Profile Details
| NPI number | 1881696490 |
|---|---|
| LBN Legal business name | Centracare Clinic |
| DBA Doing business as | Centracare Clinic - Northway Family Medicine |
| Authorized official | Blair, Michael A |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | Aug 12th, 2005 |
| Last updated | Nov 19th, 2020 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881696490 | NPPES |
| Other | NA131 | PREF ONE | |
| Other | 86D71CE | PREF ONE | |
| Other | 35580 | PREF ONE | |
| Other | 98-01806 | PREF ONE | |
| Other | 110963 | PREF ONE | |
| MEDICAID | 990228700 | PREF ONE |
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