NPIMap

Organization Active NPI

Southern Minnesota Endodontics LLC

  • Endodontics
  • Mankato, MN
National Provider Identifier
1891308979
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
Legal business name
SOUTHERN MINNESOTA ENDODONTICS LLC
Practice address
1570 Adams St
Mankato, MN 56001-5192
Phone
(507) 386-0288
NPI assigned
Aug 28, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Authorized official

Name
Sara Rundle
Title
Practice Administrator
Phone
(507) 386-0288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X Primary

Addresses

Primary practice location

1570 Adams St
Mankato, MN 56001-5192

Mailing address

1570 Adams St
Mankato, MN 56001-5192

Other names 1

  • Southern Minnesota Endodontics Doing business as

National Provider Directory

National Provider Directory

Locations

1570 Adams St
Mankato, MN 56001
Phone (507) 386-0288

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1891308979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 ADAMS ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 ADAMS ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015192",
            "telephone_number": "507-386-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MINNESOTA ENDODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-28",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "RUNDLE",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "507-386-0288"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Minnesota Endodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 28, 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.