NPIMap

Organization Active NPI

Range Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Virginia, MN
National Provider Identifier
1457452823
Registry record updated Apr 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
RANGE MENTAL HEALTH CENTER
Practice address
624 S 13TH St
Virginia, MN 55792
Phone
(218) 749-2881
Fax
(218) 749-3806
NPI assigned
Sep 26, 2006
Last updated
Apr 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2016

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

Authorized official

Name
Mary J Carpenter, MSED, LPNPI 1265533640
Title
Chief Executive Officer
Phone
(218) 749-2881

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

624 S 13TH St
Virginia, MN 55792

Mailing address

PO Box 1188
Virginia, MN 55792-1188
Phone (218) 749-2881

Other identifiers 1

IdentifierTypeStateIssuer
104855400MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040930000462 MN Part B Supplier - Clinic/Group Practice 3173434628 Receives reassigned benefits from 23 practitioners
Practice locations: Ely, MN; Hibbing, MN; Virginia, MN

National Provider Directory

National Provider Directory

Locations

111 S 4th Ave E
Ely, MN 55731
Phone (218) 365-5254

3203 3rd Ave W
Hibbing, MN 55746
Phone (218) 263-9237

504 1st St N
Virginia, MN 55792
Phone (218) 741-4714

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1457452823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1188",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557921188",
            "telephone_number": "218-749-2881",
            "fax_number": "218-749-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 S 13TH ST",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "55792",
            "telephone_number": "218-749-2881",
            "fax_number": "218-749-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANGE MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "218-749-2881",
        "authorized_official_credential": "MSED, LP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104855400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.