William Irvie Mennis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

16612 Issued in MN

Practice address

49725 County 83
Staples, MN 56479-5280

Phone

(218) 894-1515

Fax

(218) 894-1316

NPI assigned

Oct 25, 2005

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakewood Health System

  • Community/Retail Pharmacy
  • Pillager, MN
  • NPI 1396519906
  NPD (past)
• Lakewood Health System

  • Rural Health Clinic/Center
  • Pillager, MN
  • NPI 1811988983
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467442020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-1515",
            "fax_number": "218-894-1316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-1515",
            "fax_number": "218-894-1316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENNIS",
        "first_name": "WILLIAM",
        "middle_name": "IRVIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "16612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheilaine R Mabanta, M.D.
• Scott F Maney, CRNA
• Jacqueline S Mattson, PA-C
• Julie Catherine Mayers Benson, M.D.
• Emily Clara McGovern, DO
• Kelly Mae Metz, NURSE PRACTITIONER
• Amanda Mithun, LMFT
• Connie Kalal Moe, PSYD, LP
• Jordan Robert Moe, M.D.
• Adrianne Moen, M.D.

• All providers in Staples, MN
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.