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

Table of content: (NPI 1720161615)

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: 261QA1903X , with the licence number: 331023 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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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