County of Murray
Organization Active NPI Clinic/Center · Slayton, MN
NPI 1679565287 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1679565287
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- COUNTY OF MURRAY
- Practice address
- 2040 Juniper Ave
Slayton, MN 56172-1017 - Phone
- (507) 836-6153
- Fax
- (507) 836-8787
- NPI assigned
- Aug 19, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- COUNTY OF MURRAY
Authorized official
- Name
- Mel Snow
- Title
- Administrator Ceo
- Phone
- (507) 836-1277
Owners & managing parties with NPI records 1
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Facilities with the same owner 1
Practitioners 51
-
Melanie Lynn Behrends, APRN, CNP
-
Carol J Campbell, CRNA
-
Paige M Freeman, PA-C
-
Josiah A. Goldammer, D.O.
-
Tracy Lynn Hansen, APRN, FNP
-
Lawrence D Sanchez, M.D.
-
Daniel R Woldt, PA-C
-
Craig Bergh, CRNA
-
Thomas R Bergman, PA-C
-
Kyle D Busack, PA
-
Michelle E Davis, NP
-
Jennifer S. Gutierrez, M.D.
-
Leslee J Jaeger, M.D.
-
Christopher Michael Kirby, PHYSICIAN ASSISTANT
-
Timothy Andre Klassen, CRNA
-
Jason D Klein, CRNA, MS
-
Loretta Renee Krahn, CRNA
-
David Krusemark, CRNA
-
Kevin Jeffrey Mahoney, D.P.M.
-
David Andrew Majewski, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Rural health clinic certification: CCN 243417
- Legal name
- COUNTY OF MURRAY
- Doing business as
- SLAYTON CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 1, 2000
- Last certification
- Aug 28, 2012
- Ownership / control type
- Non-profit – church related
- Organization structure
- Government · Non-profit
- Incorporated
- in MN
- Enrollment address
- 2042 Juniper Ave
Slayton, MN 56172-1017
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Robyn Van Heuvelen |
Corporate Officer |
Jan 1, 2018 | |
| W-2 Managing Employee |
Jan 1, 2018 | ||
| Luke D Schryvers |
Corporate Officer |
Dec 2, 2020 | |
| County of Murray |
5% Or Greater Direct Ownership Interest | Jan 1, 1966 | 100% |
| Operational/Managerial Control | Jan 31, 2006 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Murray County Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Nov 30, 2007 |
| Murray County Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | May 1, 1950 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040211000401 | MN | Part B Supplier - Clinic/Group Practice | 7810806064 |
Receives reassigned benefits from 46 practitioners 1 other NPI on this enrollment Practice locations: Slayton, MN |
| O20040421001282 | MN | Part a Provider - Rural Health Clinic | 7810806064 | Practice locations: Slayton, MN |
National Provider Directory
- Part of
- Murray Co Mem Hosp
Locations
2711 Broadway Ave
Slayton, MN 56172
Phone (507) 836-6262
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | MN | Yes |
Addresses
Primary practice location
2040 Juniper Ave
Slayton, MN 56172-1017
Mailing address
2040 Juniper Ave
Slayton, MN 56172-1017
Phone (507) 836-6153
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 431820000 | Medicaid | MN |
Other names
- Murray County Clinic
Other providers in Slayton, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.