CENTRACARE CLINIC – NPI #1003339789
Clinic/Center

CENTRACARE CLINIC is an AHC clinic located in SAINT CLOUD, MN. NPPES has assigned the NPI number 1003339789 to CENTRACARE CLINIC on July 25, 2017. It is a Type-2 NPI, indicating this NPI number is associated with an organization. According to the NPI data, there are 2 additional location(s) assigned to this provider which are listed below. The primary taxonomy selected by this provider is 261QM1300X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Multi-Specialty

The NPI profile was last updated on Jun 23, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for CENTRACARE CLINIC below.

NPI Profile for
CENTRACARE CLINIC

NPI Number
1003339789
Enumeration Date

(about 9 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CENTRACARE CLINIC
Primary location
3701 12TH ST N STE 102
SAINT CLOUD, MN 56303-2253
Phone: (320) 656-7195 Fax:
2 Other location(s):
1555 Northway Dr Ste 110
Saint Cloud, MN 56303-1866
Phone: (320) 255-7195
Fax: (320) 200-3245
2025 Stearns Way Ste 114
Saint Cloud, MN 56303
Phone: (320) 255-7195
Fax: (320) 200-3245
Mailing address
1200 6TH AVE N
SAINT CLOUD, MN 56303-2735
Phone: (320) 252-5131 Fax: (320) 240-2118
Organization Subpart
No
Authorized Official
MICHAEL BLAIR
SR VP & CFO
Phone: (320) 255-5665
Updated
Certification Date
Jun 23, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QM1300X
- Clinic/Center / Multi-Specialty (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.