1326027244 NPI number — STEVEN P PETERSON MS, LP

Table of content: STEVEN P PETERSON MS, LP (NPI 1326027244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326027244 NPI number — STEVEN P PETERSON MS, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERSON
Provider First Name:
STEVEN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326027244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8674
Provider Second Line Business Mailing Address:
1230 E MAIN ST MANKATO CLINIC LTD
Provider Business Mailing Address City Name:
MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56002-8674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-625-1811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MADISON EAST CENTER
Provider Second Line Business Practice Location Address:
SUITE 352 MANKATO CLINIC DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-387-3195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP2984 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 114944 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 410849339 56001 C027 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NA2951012523 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 248L7PE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2409705 . This is a "AMERICAS PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 714563200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP28644 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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