CENTRACARE - BIG LAKE CLINIC – NPI #1013104348
Clinic/Center

CENTRACARE - BIG LAKE CLINIC is an AHC clinic located in BIG LAKE, MN. NPPES has assigned the NPI number 1013104348 to CENTRACARE - BIG LAKE CLINIC on October 01, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “CENTRACARE - BIG LAKE CLINIC” is a dba name, the actual legal business name for this organization is CENTRACARE CLINIC. With multiple taxonomy codes selected, 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 previously updated about 6 years ago on Nov 19, 2020. 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 - BIG LAKE CLINIC below.

NPI Profile for
CENTRACARE CLINIC

NPI Number
1013104348
Enumeration Date

(more than 18 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
Doing Business As (dba): CENTRACARE - BIG LAKE CLINIC
Primary location
16830 198TH AVE NW
CENTRACARE CLINIC - BIG LAKE
BIG LAKE, MN 55309-4860
Phone: (763) 263-7300 Fax: (763) 263-7338
Mailing address
1200 6TH AVE N
SAINT CLOUD, MN 56303-2736
Phone: (320) 229-4977 Fax: (763) 263-7338
Organization Subpart
Yes - CENTRACARE - BIG LAKE CLINIC is subpart of another organization.
Authorized Official
MICHAEL BLAIR
SR VP & CFO
Phone: (320) 255-5665
Updated
Certification Date
Nov 19, 2020

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)
332B00000X
- Durable Medical Equipment & Medical Supplies

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.