Provider Demographics
NPI:1740677509
Name:CENTRACARE CLINIC
Entity type:Organization
Organization Name:CENTRACARE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELDHEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-240-2152
Mailing Address - Street 1:471 HIGHWAY 23
Mailing Address - Street 2:P.O. BOX 218
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-9145
Mailing Address - Country:US
Mailing Address - Phone:320-968-7234
Mailing Address - Fax:
Practice Address - Street 1:471 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-9145
Practice Address - Country:US
Practice Address - Phone:320-968-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRACARE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty