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CENTRACARE LABORATORY SERVICES
Complete NPI Record 1598713075
Clinical Medical Laboratory in Saint Cloud, MN

NPI Status: Active since May 05, 2006

Contact Information

1900 CENTRACARE CIR
CENTRACARE HEALTH PLAZA
SAINT CLOUD, MN
ZIP 56303
Phone: (320) 251-2700
Fax: (320) 255-5711

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Second Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Authorized Official Last Name
  25. Authorized Official First Name
  26. Authorized Official Middle Name
  27. Authorized Official Title or Position
  28. Authorized Official Telephone Number
  29. Healthcare Provider Taxonomy Code 1
  30. Provider License Number 1
  31. Provider License Number State Code 1
  32. Healthcare Provider Primary Taxonomy Switch 1
  33. Other Provider Identifier 1
  34. Other Provider Identifier Type Code 1
  35. Other Provider Identifier State 1
  36. Other Provider Identifier 2
  37. Other Provider Identifier Type Code 2
  38. Other Provider Identifier State 2
  39. Other Provider Identifier Issuer 2
  40. Is Organization Subpart
  41. Parent Organization LBN
  42. Parent Organization TIN
  43. Authorized Official Name Prefix Text

Complete NPI Dataset

This page represents the complete record for NPI 1598713075. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1598713075
The date the provider was assigned a unique identifier (assigned an NPI).
Entity Type Code: 2
The date that a record was last updated or changed.
Employer Identification Number EIN: UNAVAIL
The code designating the provider’s gender if the provider is a person.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: CENTRACARE LABORATORY SERVICES
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 1406 6TH AVE N
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: SAINT CLOUD
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MN
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 563031900
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3202512700
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 3202555711
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1900 CENTRACARE CIR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: CENTRACARE HEALTH PLAZA
Provider Business Practice Location Address City Name: SAINT CLOUD
Provider Business Practice Location Address State Name: MN
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Provider Business Practice Location Address Postal Code: 563035000
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3202512700
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3202555711
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 5/5/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/26/2015
The date that a record was last updated or changed.
Authorized Official Last Name: KLUGHERZ
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: GREGORY
The first name of the authorized official.
Authorized Official Middle Name: R
The middle name of the authorized official.
Authorized Official Title or Position: VICE PRESIDENT AND CFO
The title or position of the authorized official.
Authorized Official Telephone Number: 3202555665
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 291U00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 24D0405790
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: MN
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 443985600
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: MN
Other Provider Identifier 2: 690009424
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: MN
Other Provider Identifier Issuer 2: RR MEDICARE
Is Organization Subpart: Y
Parent Organization LBN: CENTRACARE HEALTH SYSTEMS
Parent Organization TIN: UNAVAIL
Authorized Official Name Prefix Text: MR.