St. Cloud Hospital

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

ST. CLOUD HOSPITAL

Doing business as

CentraCare Kidney Program - Litchfield

Practice address

520 Hwy 12 East
Suite 6
Litchfield, MN 55355

Phone

(320) 240-7808

Fax

(320) 240-7840

NPI assigned

Dec 3, 2007

Organization subpart

Yes

Parent organization

ST CLOUD HOSPITALAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael A. Blair

Title

Sr. Vice President and Cfo

Phone

(320) 255-5665

Specialties & licenses 1

Addresses

Other names 1

• CentraCare Kidney Program - Litchfield Doing business as

Part of

Mid Minnesota Clinic

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• St Cloud Hospital

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Saint Cloud, MN
  • NPI 1811150618

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570665600000",
    "number": "1033391099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1406 6TH AVE N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031900",
            "telephone_number": "320-240-7808",
            "fax_number": "320-240-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 HWY 12 EAST",
            "address_2": "SUITE 6",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "55355",
            "telephone_number": "320-240-7808",
            "fax_number": "320-240-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLOUD HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST CLOUD HOSPITAL",
        "enumeration_date": "2007-12-03",
        "last_updated": "2019-10-10",
        "status": "A",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare Kidney Program - Litchfield",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CentraCare Kidney Program - Litchfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Smith
• Teresa Lynn Smith, APRN
• Michael Allen Solbrack, DDS
• Jennifer Lyn Sommerfeld, RN
• Kelly Ann Spandl, PTA
• Steven Bachman
• Anita M Strei, MD
• Ryan P Swenson, DDS
• Terrence L Tancabel, O.D.
• Bradley Eugene Teske, R.PH.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Litchfield, MN
• Providers in Litchfield, MN by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.