Organization
MANKATO CLINIC ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY FARROW (CEO)
(507) 389-8501
Entity
Organization
Contact information
Practice address
1230 E MAIN ST, MANKATO, MN 56001-5066
(800) 657-6944
Mailing address
1230 E MAIN ST, PO BOX 8674, MANKATO, MN 56001-5066
(800) 657-6944
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043482
PREFERRED ONE
MN
01
—
105111
HEALTH PARTNERS
MN
01
—
180538
UCARE MINNESOTA
MN
05
—
443100600
—
MN
01
—
6800057
MEDICA
MN
01
—
6J32MA
BLUE CROSS MN
FM
01
—
P00225672
RAILROAD MEDICARE
MN
Enumeration date
02/24/2006
Last updated
08/07/2012
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