Provider Demographics
NPI:1386629368
Name:MN STATE COLLEGES AND UNIVERSITIES
Entity Type:Organization
Organization Name:MN STATE COLLEGES AND UNIVERSITIES
Other - Org Name:MSU STUDENT HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-389-5689
Mailing Address - Street 1:600 MAYWOOD AVE
Mailing Address - Street 2:21 CARKOSKI COMMONS
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7008
Mailing Address - Country:US
Mailing Address - Phone:507-389-6276
Mailing Address - Fax:
Practice Address - Street 1:600 MAYWOOD AVE
Practice Address - Street 2:21 CARKOSKI COMMONS
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7008
Practice Address - Country:US
Practice Address - Phone:507-389-6276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN17278MAOtherBLUECROSS BLUESHIELD
MN167195OtherUCARE