CENTRACARE CLINIC (NPI# 1720500309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720500309 |
| Entity Type | Organization |
| Organization Name | CENTRACARE CLINIC |
| Other Organization Name | CENTRACARE CLINIC - ST JOHN'S |
| Practice Address |
2749 Sexton Drive Mary Hall - Room 001 Collegeville MN 56321 |
| Mailing Address |
120 6th Ave N Saint Cloud MN 56303-4748 |
| Practice Telephone | 3202003200 |
| Mailing Telephone | 3202003200 |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2019-01-14 |
| Authorized Official Name | THOMAS M FELDHEGE (TREASURER/DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 3202402152 |
| Is Organization Subpart | Y |
| Parent Organization Name | CENTRACARE CLINIC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| CentraCare Clinic - St John's | Doing Business As Name - Organization |
| CentraCare Quickclinic - St John's | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2749 Sexton Drive, Mary Hall - Room 001, Collegeville, MN 56321 | 3202003200 | |
| 2850 Abbey Plaza Hlthc 109, Collegeville, MN 56321 | (320) 251-2700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003339789 | Centracare Clinic | Clinic/Center | 2025 Stearns Way Ste 114, Saint Cloud, MN 56303 | 2017-07-25 |
| 1881116747 | Centracare Clinic | Clinic/Center | 402 Red River Ave N Ste 2, Cold Spring, MN 56320-1523 | 2017-07-12 |
| 1558898387 | Centracare Clinic | Clinic/Center | 161 Glen St., Ste 101, Foley, MN 56329 | 2017-05-11 |
| 1164958104 | Centracare Clinic | Clinic/Center | 113 Waite Ave S Ste 101, Waite Park, MN 56387-1348 | 2017-05-11 |
| 1770020489 | Centracare Clinic | Clinic/Center | 2001 Stockinger Drive, Suite 101, St Cloud, MN 56303 | 2017-01-20 |
| 1679025746 | Centracare Clinic | Clinic/Center | 7418 Forthun Rd, Baxter, MN 56425-8702 | 2016-10-25 |
| 1962958611 | Centracare Clinic | Exclusive Provider Organization | 166 19th Street S, Suite 202, Sartell, MN 56377 | 2016-08-31 |
| 1700281953 | Centracare Clinic | Urology | 2351 Connecticut Ave S, Suite 200, Centracare Clinic- Adult & Pediatric Urology, Sartell, MN 56377-2477 | 2014-10-30 |
| 1043212665 | Centracare Clinic | Clinic/Center | 1200 Sixth Ave No, Centracare Clinic, St Cloud, MN 56303-2735 | 2005-08-12 |
| 1881696490 | Centracare Clinic | Durable Medical Equipment & Medical Supplies | 1555 Northway Drive, St Cloud, MN 56303 | 2005-08-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CENTRACARE CLINIC RIVER CAMPUS | 1200 6th Ave N, Saint Cloud, MN 56303-2735 |
| Street Address |
2749 SEXTON DRIVE MARY HALL - ROOM 001 |
| City | COLLEGEVILLE |
| State | MN |
| Zip Code | 56321 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487048351 | Justin Michael Rost | Specialist/Technologist | 2850 Abbey Plaza, Collegeville, MN 56321 | 2015-03-27 |
| 1467855270 | Michelle Stemper | Specialist/Technologist | 2585 Abbey Rd, Warner Palaestra, Collegeville, MN 56321 | 2014-10-07 |
| 1417350406 | Holly Nichole Remmenga | Specialist/Technologist | 2585 Abbey Road, Collegeville, MN 56321 | 2014-10-03 |
| 1538102520 | Gayle Christine Leen | Physician Assistant | Centracare Clinic St John's, 2850 Abbey Plaza Hlthc 109, Collegeville, MN 56321 | 2006-06-14 |
| 1770946584 | Samantha Bethany Taylor | Specialist/Technologist | 2585 Abbey Road, Collegeville, MN 56321 | 2016-03-30 |
| 1942578620 | Group Health Plan, Inc. | Durable Medical Equipment & Medical Supplies | 31802 County Road 159, Collegeville, MN 56321-7177 | 2011-12-08 |
| 1013970003 | Scott Robert Bierscheid | Specialist/Technologist | Saint John's University, Box 7277, Collegeville, MN 56321-7277 | 2006-04-10 |
| 1144226226 | Order of St. Benedict | Clinic/Center | 112 Abbey Rd, Collegeville, MN 56321-7777 | 2005-06-23 |
| 1841296910 | Eileen Johanna Haeg | Physician Assistant | 112 Abbey Rd, Collegeville, MN 56321-7777 | 2005-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548879133 | Natalia Snyder | Physician Assistant | 555 Second Ave Ste C-300, Collegeville, PA 19426-3637 | 2020-07-29 |
| 1427666726 | Chu Chian Chong | Psychologist | 510 Brighton Rd, Collegeville, PA 19426-1756 | 2020-07-22 |
| 1013534734 | Gentle Hands Total Home Care Services LLC | Home Health | 972 Dogwood Ln, Collegeville, PA 19426-4125 | 2020-06-29 |
| 1639706906 | Anita Ross | Occupational Therapist | 11 Leatherwood Dr, Collegeville, PA 19426-3903 | 2020-03-25 |
| 1033743992 | The Dental Spot, LLC | Clinic/Center | 222 E Main St # 1c, Collegeville, PA 19426-2650 | 2020-02-28 |
| 1306479639 | Erin E Perveiler | Social Worker | 555 Second Ave Bldg B3, Collegeville, PA 19426-3600 | 2020-02-14 |
| 1063057040 | Oswaldo Giovanni Tagle Manrique | Physician Assistant | 1200 Mokychic Road, Collegeville, PA 19426 | 2019-11-13 |
| 1558904813 | Joseph Richard Gagnon Jr. | Registered Nurse | 3774 Ridge Pike Rear 2, Collegeville, PA 19426-3153 | 2019-10-18 |
| 1588214555 | Hope Frances Nester | Counselor | 4039 Steeplechase Dr, Collegeville, PA 19426-1266 | 2019-09-12 |
| 1114573102 | Melissa Anne Baldrige | Registered Nurse | 409 Second Ave Ste 303, Collegeville, PA 19426-3662 | 2019-08-14 |
| Find all providers in COLLEGEVILLE | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376079798 | Medical Care Innovation, P.C. | Clinic/Center | 400 Arcola Rd, Collegeville, PA 19426-2914 | 2017-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003423252 | Good Clinic Mn Pllc | Clinic/Center | 315 1st Ave Ne, Minneapolis, MN 55413-5001 | 2020-09-30 |
| 1407496219 | Hope Health Initiative | Clinic/Center | 6818 Humboldt Ave N, Brooklyn Center, MN 55430-1536 | 2020-01-09 |
| 1902392525 | Odam Medical Group | Clinic/Center | 3405 3rd St N, Saint Cloud, MN 56303-4015 | 2018-07-06 |
| 1376041822 | Piic Clinical Services | Clinic/Center | 6500 Humboldt Ave N, Brooklyn Center, MN 55430-1800 | 2018-01-30 |
| 1760905475 | Patient Centered Care | Clinic/Center | 8240 Hampshire Ct N, Brooklyn Park, MN 55445 | 2017-07-25 |
| 1740703339 | Neopath | Clinic/Center | 119 30th Ave W Ste 119, Alexandria, MN 56308-3433 | 2017-07-25 |
| 1881116747 | Centracare Clinic | Clinic/Center | 402 Red River Ave N Ste 2, Cold Spring, MN 56320-1523 | 2017-07-12 |
| 1558898387 | Centracare Clinic | Clinic/Center | 161 Glen St., Ste 101, Foley, MN 56329 | 2017-05-11 |
| 1164958104 | Centracare Clinic | Clinic/Center | 113 Waite Ave S Ste 101, Waite Park, MN 56387-1348 | 2017-05-11 |
| 1306388269 | Quadmed Medical Clinics of Minnesota, P.C. | Clinic/Center | 9000 Plymouth Ave N, Golden Valley, MN 55427-3870 | 2016-11-09 |
| Find all providers with the same taxonomy | ||||
| City | COLLEGEVILLE |
| Zip Code | 56321 |
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| 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.