1952359614 NPI number — CENTRACARE HEALTH SYSTEM - LONG PRAIRIE

Table of content: (NPI 1952359614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952359614 NPI number — CENTRACARE HEALTH SYSTEM - LONG PRAIRIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRACARE HEALTH SYSTEM - LONG PRAIRIE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952359614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 CENTRA CARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG PRAIRIE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56347-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-256-4231
Provider Business Mailing Address Fax Number:
320-256-4949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 CENTRACARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG PRAIRIE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-732-2141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLAIR
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
SR. VICE PRESIDENT AND CFO
Authorized Official Telephone Number:
320-255-5665

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  331051 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 556717300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com