MANKATO CLINIC, LTD (NPI# 1558652362) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558652362 |
| Entity Type | Organization |
| Organization Name | MANKATO CLINIC, LTD |
| Other Organization Name | LAKE CRYSTAL FAMILY PRACTICE |
| Practice Address |
221 S Murphy St Lake Crystal MN 56055-2128 |
| Mailing Address |
6501 City West Pkwy Eden Prairie MN 55344-3248 |
| Practice Telephone | 5077262136 |
| Mailing Telephone | 9526532525 |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |
| Authorized Official Name | RANDY FARROW (CEO) |
| Authorized Official Telephone | 5073898501 |
| Is Organization Subpart | Y |
| Parent Organization Name | MANKATO CLINIC, LTD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| Other Name | Type Code |
|---|---|
| Lake Crystal Family Practice | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255623765 | Mankato Clinic, Ltd | Non-Pharmacy Dispensing Site | 305 Main St Ne, Mapleton, MN 56065 | 2011-05-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MANKATO CLINIC, LTD. | 1230 E Main St, Mankato, MN 56001-5066 |
| Street Address |
221 S MURPHY ST |
| City | LAKE CRYSTAL |
| State | MN |
| Zip Code | 56055-2128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518946532 | Kirk M Odden | Family Medicine | 221 S Murphy St, Lake Crystal, MN 56055-2128 | 2006-01-10 |
| 1730799826 | Elissa Marget Karels | Nurse Practitioner | 221 S Murphy St, Lake Crystal, MN 56055-2128 | 2020-08-04 |
| 1386962447 | Darlene I Schauer | Physician Assistant | 221 S Murphy St, Lake Crystal, MN 56055-2128 | 2010-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700943115 | Judith Kaye Swezey | Optometrist | 102 W Humphrey St, Lake Crystal, MN 56055 | 2007-01-03 |
| 1467524371 | Jackson Chiropractic of Lake Crystal | Chiropractor | 242 Hiway 60, Unit 4, Lake Crystal, MN 56055 | 2006-11-15 |
| 1902976251 | Donald Del Campbell Jr. | Dentist | 131 N Lincoln St, Lake Crystal, MN 56055 | 2006-11-08 |
| 1447330022 | Leif Christian Helling | Chiropractor | 242 Highway 60, Unit 4, Lake Crystal, MN 56055 | 2006-10-17 |
| 1730306838 | M and J Lokensgard Inc | Pharmacy | 142 S Main Street, Lake Crystal, MN 56055 | 2007-04-19 |
| 1104864149 | Thro Company | Skilled Nursing Facility | 202 Laclaire St Box 60, Lake Crystal Health Care Center, Lake Crystal, MN 56055-0060 | 2006-06-03 |
| 1679584205 | City of Lake Crystal | Ambulance | 181 S Hunt Street, Lake Crystal, MN 56055-0086 | 2006-08-10 |
| 1740309640 | Crystal View Eye Care | Optometrist | 102 W Humphrey St, Lake Crystal, MN 56055-0158 | 2007-03-29 |
| 1740477611 | Lake Crystal Wellcome Memorial Area Schools | Local Education Agency (LEA) | 607 Knights Ln, Lake Crystal, MN 56055-0160 | 2007-09-25 |
| 1699266882 | Kristi Shay Freerksen | Registered Nurse | 326 N Main St, Lake Crystal, MN 56055-0915 | 2018-05-23 |
| Find all providers in zip 56055 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518528397 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | Fairview Lakeville Clinic Mtm, 18580 Joplin Ave, Lakeville, MN 55044 | 2019-06-24 |
| 1851856504 | Tareen Dermatology, Pa | Non-Pharmacy Dispensing Site | 2945 Hazelwood St Ste 230, Maplewood, MN 55109-1241 | 2019-02-07 |
| 1417450651 | Cerner Health Connections, Inc | Non-Pharmacy Dispensing Site | 4001 Lexington Ave N Ste C2-435, Arden Hills, MN 55126-2934 | 2018-03-14 |
| 1316461593 | Fairview Pharmacy Service LLC | Non-Pharmacy Dispensing Site | 7250 France Ave S Ste 410, Edina, MN 55435-4314 | 2017-07-31 |
| 1346653052 | Advanced Spine and Pain Clinics of Mn, LLC | Non-Pharmacy Dispensing Site | 308 Brighton Ave, Suite D, Buffalo, MN 55313-2303 | 2014-06-10 |
| 1407296148 | Group Health Plan Inc | Non-Pharmacy Dispensing Site | 1833 2nd Ave, Anoka, MN 55303-2432 | 2013-06-26 |
| 1295178135 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 6440 Nicollet Ave South, Richfield, MN 55423-1613 | 2013-04-10 |
| 1992148845 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 2450 Riverside Ave South, Minneapolis, MN 55454-1400 | 2013-04-10 |
| 1083984876 | Mayo Clinic Health System-southeast Minnesota Region | Non-Pharmacy Dispensing Site | 32021 County 24 Boulevard, Cannon Falls, MN 55009-1824 | 2012-01-10 |
| 1255623765 | Mankato Clinic, Ltd | Non-Pharmacy Dispensing Site | 305 Main St Ne, Mapleton, MN 56065 | 2011-05-03 |
| Find all providers with the same taxonomy | ||||
| City | LAKE CRYSTAL |
| Zip Code | 56055 |
Please comment or provide details below to improve the information on MANKATO CLINIC, LTD.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.