Organization
MANKATO CLINIC EXPRESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY FARROW (CHIEF EXECUTIVE OFFICER)
(507) 389-8501
Entity
Organization
Contact information
Practice address
1850 ADAMS ST, SUITE 130, MANKATO, MN 56001-4864
(507) 625-1811
Mailing address
1850 ADAMS ST, SUITE 130, MANKATO, MN 56001-4864
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/05/2007
Last updated
11/12/2009
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