Provider Demographics
NPI:1720161615
Name:MANKATO SURGICAL CENTER, L.L.C.
Entity Type:Organization
Organization Name:MANKATO SURGICAL CENTER, L.L.C.
Other - Org Name:MANKATO SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER/BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-388-6000
Mailing Address - Street 1:1411 PREMIERE DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6076
Mailing Address - Country:US
Mailing Address - Phone:507-388-6000
Mailing Address - Fax:507-388-6913
Practice Address - Street 1:1411 PREMIERE DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-388-6000
Practice Address - Fax:507-388-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 367500000X
MN331023261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM7C61MAOtherBLUE CROSS PROVIDER NUMBE
MN86783OtherHEALTH PARTNERS PROVIDER
MN163458500Medicaid
MN1031138OtherPREFERRED ONE PROVIDER NU
MN170117OtherUCARE PROVIDER NUMBER
MN6800031OtherMEDICA PROVIDER NUMBER
MN6800031OtherMEDICA PROVIDER NUMBER