MEDICARE: MSOCS-AUSTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356414163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSOCS-AUSTIN

Provider Business Mailing Address
First Line	:	PO BOX 64979
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55164-0979
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 12TH ST SW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-2662
Country	:	US
Telephone Number	:	507-433-9027
Fax Number	:

Authorized Official
Title or Position	:	RESIDENTIAL PROG SVCS DIRECTOR
Name	:	ROGER DENEEN
Credential	:
Telephone Number	:	651-582-1857

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	06/18/2008

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Directions to “MSOCS-AUSTIN ” Practice Location

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