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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679430110
- **Authorized official:** MARK MOGENSEN PA-C (PROVIDER)
- **Authorized official phone:** (712) 830-4840

## Contact information

- **Practice address:** 801 HUDSON ST, LAKE VIEW, IA 51450
- **Practice address phone:** (712) 830-4840
- **Practice address fax:** (877) 330-2377
- **Mailing address:** 460 N STATE RD, LAKE VIEW, IA 51450-7307
- **Mailing address phone:** (712) 830-3170
- **Mailing address fax:** (877) 330-2377

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/07/2026
- **Last updated:** 09/09/2026