Mid-Minnesota Neurology Clinic, P.a.

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

37961 Issued in MN

Legal business name

MID-MINNESOTA NEUROLOGY CLINIC, P.A.

Practice address

206 Pine St
Monticello, MN 55362-8665

Phone

(763) 295-3844

NPI assigned

Oct 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Thanh K. Dang, M.D.

Title

Ceo/Owner

Phone

(763) 497-9906

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154416402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13985 OAKWOOD CT NE",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553764514",
            "telephone_number": "763-497-9906",
            "fax_number": "763-497-9906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 PINE ST",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628665",
            "telephone_number": "763-295-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-MINNESOTA NEUROLOGY CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DANG",
        "authorized_official_first_name": "THANH",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "763-497-9906",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MN",
            "license": "37961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2065185",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "785177",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0500702",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "362G7MI",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "J254",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelley M McGowan, PT
• Celina Mae McKenzie, BCTMB, CR, CIMT
• Eric Andrew Melendez, DPT
• Anna Christine Messerly, DPT
• Bill Everett Mickle, D.C.
• Midwest Rehabilitation Supply, LLC
• Kiley Marie Milless
• Felicia Anna Mills
• Minnesota Ya Services LLC
• Monticello Big Lake Community Hospital

• Medical Specialty Clinic/Center in Monticello, MN
• Providers in Monticello, MN by specialty
• Medical Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.