St. Cloud Hospital

Primary specialty

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

Legal business name

ST. CLOUD HOSPITAL

Practice address

403 East Prairie Ave
Staples, MN 56479

Phone

(218) 894-0026

Fax

(320) 656-7009

NPI assigned

May 10, 2006

Reactivated

Sep 10, 2024

Organization subpart

No

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 2

Addresses

Other identifiers 1

Other names 1

• CentraCare Kidney Program - Staples Dialysis Doing business as

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

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1922057421",
    "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": "320-251-2700",
            "fax_number": "320-656-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 EAST PRAIRIE AVE",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "56479",
            "telephone_number": "218-894-0026",
            "fax_number": "320-656-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLOUD HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2024-09-10",
        "deactivation_date": "2024-07-31",
        "reactivation_date": "2024-09-10",
        "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": "MN",
            "license": "331506",
            "primary": false
        },
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883747300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CentraCare Kidney Program - Staples Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CentraCare Kidney Program - Staples Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan Skoog
• Lisa Mary Smeby, NP
• Spandl Chiropractic P.C.
• Brockston Anthony Spandl, D.C.
• St Joseph'S Medical Center
• Staples Eye Clinic PSC
• Staples Smiles
• Wade T Swenson II, MD
• Kelly Rose Taffe, SLP
• Debra Tastad, RN,CNS

• All providers in Staples, MN
• 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 Sep 10, 2024; 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.