Provider Demographics
NPI:1639838865
Name:MN OPERATIONS LLC
Entity Type:Organization
Organization Name:MN OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:AHLQUIST
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:208-810-2298
Mailing Address - Street 1:2775 W NAVIGATOR DR STE 220
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7592
Mailing Address - Country:US
Mailing Address - Phone:208-440-8496
Mailing Address - Fax:
Practice Address - Street 1:2775 W NAVIGATOR DR STE 220
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7592
Practice Address - Country:US
Practice Address - Phone:208-440-8496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty