NPIMap

Organization Active NPI

Medcentra LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Saint Paul, MN
National Provider Identifier
1851388920
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
MEDCENTRA LLC
Practice address
225 Smith Ave N
Suite 301
Saint Paul, MN 55102-2534
Phone
(651) 288-5180
Fax
(651) 288-5188
NPI assigned
Oct 4, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Brian David Siska
Title
President/
Phone
(763) 545-3006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Primary

Addresses

Primary practice location

225 Smith Ave N
Suite 301
Saint Paul, MN 55102-2534

Mailing address

225 Smith Ave N
Suite 301
Saint Paul, MN 55102-2534
Phone (651) 288-5180

National Provider Directory

National Provider Directory

Locations

5851 Duluth St
Ste 301
Golden Valley, MN 55422
Phone (763) 522-0044

2785 White Bear Ave N
Ste 300
Maplewood, MN 55109
Phone (651) 777-0733

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1851388920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 SMITH AVE N",
            "address_2": "SUITE 301",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022534",
            "telephone_number": "651-288-5180",
            "fax_number": "651-288-5188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 SMITH AVE N",
            "address_2": "SUITE 301",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022534",
            "telephone_number": "651-288-5180",
            "fax_number": "651-288-5188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDCENTRA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SISKA",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/",
        "authorized_official_telephone_number": "763-545-3006",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.