NPIMap

Organization Active NPI

Mankato Clinic Express, LLC

  • Physician Assistant
  • Mankato, MN
National Provider Identifier
1265626964
Registry record updated Nov 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
MANKATO CLINIC EXPRESS, LLC
Practice address
1850 Adams St
Suite 130
Mankato, MN 56001-4864
Phone
(507) 625-1811
NPI assigned
Sep 5, 2007
Last updated
Nov 12, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2009

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

Authorized official

Name
Mr. Randy Farrow
Title
Chief Executive Officer
Phone
(507) 389-8501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

1850 Adams St
Suite 130
Mankato, MN 56001-4864

Mailing address

1850 Adams St
Suite 130
Mankato, MN 56001-4864

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1850 Adams St
#10
Mankato, MN 56001

1850 Adams St
Ste 130
Mankato, MN 56001

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257984000000",
    "number": "1265626964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 ADAMS ST",
            "address_2": "SUITE 130",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 ADAMS ST",
            "address_2": "SUITE 130",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014864",
            "telephone_number": "507-625-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANKATO CLINIC EXPRESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2009-11-12",
        "status": "A",
        "authorized_official_last_name": "FARROW",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "507-389-8501",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; 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.