Provider Demographics
NPI:1720210099
Name:WINONA HEALTH SERVICES
Entity Type:Organization
Organization Name:WINONA HEALTH SERVICES
Other - Org Name:WINONA HEALTH SERVICES PHYSICIAN GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSNAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-454-3650
Mailing Address - Street 1:855 MANKATO AVE
Mailing Address - Street 2:PO BOX 5600
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4868
Mailing Address - Country:US
Mailing Address - Phone:507-457-4321
Mailing Address - Fax:507-474-3224
Practice Address - Street 1:855 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4868
Practice Address - Country:US
Practice Address - Phone:507-457-4321
Practice Address - Fax:507-474-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
MN331049282N00000X
MN350478332B00000X, 332BC3200X, 335E00000X
MN347609332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332H00000XSuppliersEyewear Supplier
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11004400Medicaid
MN38040COOtherBLUE SHIELD
MN124847200Medicaid
24D0041006OtherCLIA
WI11004400Medicaid