1255472957 NPI number — INDEPENDENT MANAGEMENT SERVICES OF MN, INC.

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 1255472957 NPI number — INDEPENDENT MANAGEMENT SERVICES OF MN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT MANAGEMENT SERVICES OF MN, INC.
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:
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:
1255472957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 21ST ST SE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55912-4322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-437-6389
Provider Business Mailing Address Fax Number:
507-437-0977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 21ST ST SE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55912-4322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-437-6389
Provider Business Practice Location Address Fax Number:
507-437-0977
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THORSON
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
507-437-6389

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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