Provider Demographics
NPI:1982313045
Name:MANKATO TMS PLLC
Entity Type:Organization
Organization Name:MANKATO TMS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:507-740-0467
Mailing Address - Street 1:120 OAK MARSH DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-8762
Mailing Address - Country:US
Mailing Address - Phone:507-613-3883
Mailing Address - Fax:360-282-1236
Practice Address - Street 1:1400 MADISON AVE STE 602
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5488
Practice Address - Country:US
Practice Address - Phone:507-740-0467
Practice Address - Fax:360-282-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty