Provider Demographics
NPI:1518066646
Name:CHASKA MEDICAL CENTER
Entity Type:Organization
Organization Name:CHASKA MEDICAL CENTER
Other - Org Name:CROSSROADS MEDICAL CENTERS, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:REKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-0529
Mailing Address - Street 1:3000 N CHESTNUT ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-3054
Mailing Address - Country:US
Mailing Address - Phone:952-448-2050
Mailing Address - Fax:952-448-2185
Practice Address - Street 1:3000 N CHESTNUT ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-3054
Practice Address - Country:US
Practice Address - Phone:952-448-2050
Practice Address - Fax:952-448-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51172CHOtherMN BCBS ID NUMBER
MN51172CHOtherMN BCBS ID NUMBER