Provider Demographics
NPI:1255472957
Name:INDEPENDENT MANAGEMENT SERVICES OF MN, INC.
Entity Type:Organization
Organization Name:INDEPENDENT MANAGEMENT SERVICES OF MN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:THORSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-437-6389
Mailing Address - Street 1:101 21ST ST SE STE 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-4322
Mailing Address - Country:US
Mailing Address - Phone:507-437-6389
Mailing Address - Fax:507-437-0977
Practice Address - Street 1:101 21ST ST SE STE 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-4322
Practice Address - Country:US
Practice Address - Phone:507-437-6389
Practice Address - Fax:507-437-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN711171100Medicare UPIN