CENTRACARE HEALTH - PAYNESVILLE LLC (NPI# 1760440846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760440846 |
| Entity Type | Organization |
| Organization Name | CENTRACARE HEALTH - PAYNESVILLE LLC |
| Other Organization Name | CENTRACARE HEALTH - PAYNESVILLE PHARMACY |
| Practice Address |
200 W 1st St Paynesville MN 56362 |
| Mailing Address |
200 W 1st St Paynesville MN 56362-1445 |
| Practice Telephone | 3202433767 |
| Practice Fax Number | 3202437519 |
| Mailing Telephone | 3202433767 |
| Mailing Fax Number | 3202437519 |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-10-10 |
| Authorized Official Name | MR. MICHAEL A. BLAIR (SR. VICE PRESIDENT AND CFO) |
| Authorized Official Telephone | 3202555665 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HOSP. PRIMEWEST | 03072202705 | 01 | |
| HOSP. MEDICA | 5003780 | 01 | |
| HOSP. PREF. ONE | 1006079 | 01 | |
| HOSP. UCARE | 300173 | 01 | |
| HOSP. HEALTH PARTNERS | 10141401 | 01 | |
| HOSP & SWING BED BCBS | 1802HPA | 01 | |
| MN | 333747200 | 05 |
| Other Name | Type Code |
|---|---|
| CentraCare Health - Paynesville Pharmacy | Doing Business As Name - Organization |
| Street Address |
200 W 1ST ST |
| City | PAYNESVILLE |
| State | MN |
| Zip Code | 56362 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942291539 | Kristine M Cervin | Pharmacist | 200 W 1st St, Paynesville, MN 56362-1445 | 2005-11-02 |
| 1356942478 | Atuobi Nana Yiadom | Pharmacist | 200 W 1st St, Paynesville, MN 56362-1445 | 2020-11-04 |
| 1427568500 | Sarah Jane Revermann | Nurse Practitioner | 200 W 1st St, Paynesville, MN 56362-1445 | 2017-10-03 |
| 1225550858 | Thakul None Rattanasuwan | Pharmacist | 200 W 1st St, Paynesville, MN 56362-1445 | 2017-07-14 |
| 1982152161 | Erin Warner | Pharmacist | 200 W 1st St, Paynesville, MN 56362-1445 | 2016-09-15 |
| 1356795108 | John Kenneth Tronnes | Family Medicine | 200 W 1st St, Paynesville, MN 56362-1445 | 2016-04-18 |
| 1194100164 | Wendy Michelle Miller | Registered Nurse | 200 W 1st St, Paynesville, MN 56362-1445 | 2015-07-20 |
| 1447679188 | Christopher Anderson | Family Medicine | 200 W 1st St, Paynesville, MN 56362-1445 | 2014-04-09 |
| 1457786972 | Centracare Health-paynesville LLC | Medicare Defined Swing Bed Unit | 200 W 1st St, Paynesville, MN 56362-1445 | 2013-09-04 |
| 1033543921 | Centracare Health-paynesville LLC | Skilled Nursing Facility | 200 W 1st St, Paynesville, MN 56362-1445 | 2013-08-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174055321 | Ginelle Rae Zimmerman | Family Medicine | 200 W 1st Street, Paynesville, MN 56362 | 2017-03-28 |
| 1710173877 | Jennifer Ann Klocker | Pharmacist | 200 West First Street, Paynesville, MN 56362 | 2007-09-21 |
| 1033322599 | Teresa Marie Winter | Massage Therapist | 750 State Hwy 55, Paynesville, MN 56362 | 2007-05-08 |
| 1336225838 | Donald Arther Millner | Dentist | 204 West James Street, Paynesville, MN 56362 | 2006-10-27 |
| 1760485908 | Todd D Lemke | Pharmacist | 200 First St W, Paynesville, MN 56362 | 2005-05-23 |
| 1275846487 | Paynesville Area Living At Home Block Nurse Program | Voluntary or Charitable | 1105 W Main St, Paynesville, MN 56362-1000 | 2010-07-16 |
| 1801420039 | Recovery Center LLC | Substance Abuse Rehabilitation Facility | 109 W James St, Paynesville, MN 56362-1216 | 2020-02-26 |
| 1932404688 | Serenity Path Inc. | Clinic/Center | 117 W James St, Box 3, Paynesville, MN 56362-1216 | 2011-01-11 |
| 1730709007 | Lisa Joy Klein-conrad | Counselor | 117 W James St, Paynesville, MN 56362-1216 | 2020-04-16 |
| 1083256002 | Lauren A Foster | Peer Specialist | 117 W James St, Paynesville, MN 56362-1216 | 2019-10-10 |
| Find all providers in zip 56362 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639251424 | Nudak Ventures LLC | Pharmacy | 216 Washburne Ave, Paynesville, MN 56362-1643 | 2006-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114544822 | Rolseth Drug Co | Pharmacy | 26709 Forest Blvd, Wyoming, MN 55092-8022 | 2020-06-29 |
| 1962037242 | United Community Pharmacy Corporation | Pharmacy | 2500 Highway 88 Ste 105, St Anthony, MN 55418-4138 | 2020-03-07 |
| 1629613005 | Lotus Ltc Pharmacy, LLC | Pharmacy | 9850 51st Ave N Ste 102, Plymouth, MN 55442-3271 | 2019-11-09 |
| 1720541337 | Ltc Prescription Providers #2 | Pharmacy | 220 1/2 Third Avenue, Proctor, MN 55810 | 2019-04-10 |
| 1639634710 | Lewis Family Drug, LLC | Pharmacy | 1105 13th Ave S, Saint James, MN 56081 | 2019-02-04 |
| 1033680046 | Brainerd Medical Center Inc | Pharmacy | 280 Barclay Ave W, Ste 1100, Pine River, MN 56474 | 2018-12-17 |
| 1457832909 | Black Forest Pharmacy Services Ltd | Pharmacy | 108 S 6th St Ste 1, Brainerd, MN 56401-3594 | 2018-08-23 |
| 1467932905 | Watertown Pharmacy LLC | Pharmacy | 204 Lewis Ave S Ste 101, Watertown, MN 55388-4501 | 2018-08-15 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1346757457 | Twin Valley Pharmacy LLC | Pharmacy | 108 Viking Ave W., Ulen, MN 56585 | 2018-01-10 |
| Find all providers with the same taxonomy | ||||
| City | PAYNESVILLE |
| Zip Code | 56362 |
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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.