1720161615 NPI number — MANKATO SURGICAL CENTER, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720161615 NPI number — MANKATO SURGICAL CENTER, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANKATO SURGICAL CENTER, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1720161615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1411 PREMIERE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56001-6076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-388-6000
Provider Business Mailing Address Fax Number:
507-388-6913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 PREMIERE DR
Provider Second Line Business Practice Location Address:
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:
507-388-6000
Provider Business Practice Location Address Fax Number:
507-388-6913
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EBERT
Authorized Official First Name:
SARA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CONTROLLER/BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
507-388-6000

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X , with the licence number: 331023 , 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: 7C61MA . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 86783 . This is a "HEALTH PARTNERS PROVIDER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 163458500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1031138 . This is a "PREFERRED ONE PROVIDER NU" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 170117 . This is a "UCARE PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6800031 . This is a "MEDICA PROVIDER NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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