NPIMap

Organization Active NPI

Mankato Clinic LTD

Doing business as Mankato Clinic - Daniels Health Center

  • Non-Pharmacy Dispensing Site
  • Saint Peter, MN
National Provider Identifier
1952576126
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
34593 Issued in MN
Legal business name
MANKATO CLINIC LTD
Doing business as
Mankato Clinic - Daniels Health Center
Practice address
1901 Old Minnesota Ave
Saint Peter, MN 56082-1763
Phone
(507) 934-2325
NPI assigned
Apr 28, 2008
Last updated
Oct 22, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

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

Authorized official

Name
Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 34593 MN Primary

Addresses

Primary practice location

1901 Old Minnesota Ave
Saint Peter, MN 56082-1763

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705
Phone (858) 625-2990

Other names 1

  • Mankato Clinic - Daniels Health Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1016491Mankato Clinic at Daniels Health Center1901 Old Minnesota Avenue, Saint Peter, MN 56082ComplianceNov 2, 2027
24D2095017Mankato Clinic at Daniels Health Center1901 Old Minnesota Ave, Saint Peter, MN 56082Certificate of waiverApr 27, 2027

National Provider Directory

National Provider Directory
Part of
Medvantx Inc

Locations

1901 Old Minnesota Ave
Saint Peter, MN 56082
Phone (507) 934-2325

Practitioners & affiliated clinicians

Practitioners 9

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": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1952576126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705",
            "telephone_number": "858-625-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 OLD MINNESOTA AVE",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560821763",
            "telephone_number": "507-934-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANKATO CLINIC LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2008-04-28",
        "last_updated": "2012-10-22",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "MN",
            "license": "34593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mankato Clinic - Daniels Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Peter, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.