ST CLOUD MEDICAL GROUP PA (NPI# 1487690996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487690996 |
| Entity Type | Organization |
| Organization Name | ST CLOUD MEDICAL GROUP PA |
| Practice Address |
251 County Road 120 Saint Cloud MN 56303-4872 |
| Practice Telephone | 3202028949 |
| Practice Fax Number | 3202020756 |
| Mailing Telephone | 3202028949 |
| Mailing Fax Number | 3202020756 |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2011-10-06 |
| Authorized Official Name | CHRISTOPHER TACL (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 3202028949 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 175710500 | 05 |
| Street Address |
251 COUNTY ROAD 120 |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-4872 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285630145 | Traese Yolanda Kuhl | Family Medicine | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2005-06-24 |
| 1205435773 | Cassandra Lee Ackerman | Nurse Practitioner | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2020-10-25 |
| 1164040804 | Jaren Steven Lukach | Nurse Practitioner | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2020-07-09 |
| 1164055505 | Anne Elizabeth Cullen | Physician Assistant | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2020-02-13 |
| 1952870339 | Ellyn Marie Phearman | Physician Assistant | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2018-11-15 |
| 1528535390 | Kellee Rucks | Family Medicine | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2018-10-30 |
| 1700399649 | Joan Marie Kotila | Registered Nurse | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-11-14 |
| 1689196339 | Centracare Clinic | Clinic/Center | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-07-14 |
| 1952849069 | Christina Ringsmuth Mohs | Physician Assistant | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-02-09 |
| 1225576598 | Jessica Barto | Nurse Practitioner | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2017-02-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003339789 | Centracare Clinic | Clinic/Center | 2025 Stearns Way Ste 114, Saint Cloud, MN 56303 | 2017-07-25 |
| 1407858020 | Centracare Clinic | Clinic/Center | 1900 Centracare Cir, Centracare Clinic Health Plaza, Saint Cloud, MN 56303-5000 | 2005-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245855162 | The Duluth Clinic Ltd | Clinic/Center | 1600 Miller Trunk Hwy Ste 1300, Duluth, MN 55811-5640 | 2020-06-16 |
| 1184250060 | Premise Health of Minnesota Medical P C | Clinic/Center | 1906 8th St Nw, Austin, MN 55912-2473 | 2020-03-23 |
| 1053952606 | Fairview Express Care | Clinic/Center | 2512 6th Street, Suite F105, Minneapolis, MN 55454-1401 | 2019-10-04 |
| 1730731464 | St Marys Regional Health Center | Clinic/Center | 1103 1st St E, Park Rapids, MN 56470 | 2019-07-12 |
| 1003478892 | The Duluth Clinic Ltd | Clinic/Center | 4289 Ugstad Rd, Hermantown, MN 55811-3615 | 2019-07-02 |
| 1073005856 | Arbor Integrative Behavioral Health | Clinic/Center | 1000 E 1st St Ste 105, Duluth, MN 55805-2297 | 2018-06-06 |
| 1689161077 | Chs Tennessee Medical P C | Clinic/Center | 701 Brooks Ave S, Thief River Falls, MN 56701-2757 | 2018-04-20 |
| 1427557867 | Gillette Children's Specialty Healthcare | Clinic/Center | 505 Paul Bunyan Dr Nw, Bemidji, MN 56601-2400 | 2018-02-11 |
| 1992224331 | Orthopedic & Sports Physical Therapy, Inc. | Clinic/Center | 322 N Tower Rd, Fergus Falls, MN 56537-1015 | 2017-09-18 |
| 1063942977 | Deer River Healthcare Center Inc | Clinic/Center | 1542 Golf Course Rd Ste 202, Grand Rapids, MN 55744-3557 | 2017-06-13 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
Please comment or provide details below to improve the information on ST CLOUD MEDICAL GROUP PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.