MEDICARE: MARY T ASSOCIATES INC

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	801456	MN
2	315P00000X	Intellectual Disabilities Intermediate Care Facility	801457	MN
3	315P00000X	Intellectual Disabilities Intermediate Care Facility	801459	MN
4	315P00000X	Intellectual Disabilities Intermediate Care Facility	801458	MN
5	251E00000X	Home Health Agency	331577	MN

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
2	131415	OTHER	MN	U CARE HHA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	102207	OTHER	MN	HEALTH PARTNERS
6	136968	OTHER	MN	U CARE PCA
7	9394AB	OTHER	MN	BCBS
8	104337	OTHER	FM	U CARE FC
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770643694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY T ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1555 118TH LN NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-7579
Country	:	US
Telephone Number	:	763-862-5436
Fax Number	:	763-754-0332

Provider Business Practice Location Address
First Line	:	1555 118TH LN NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-7579
Country	:	US
Telephone Number	:	763-862-5436
Fax Number	:	763-754-0332

Authorized Official
Title or Position	:	CONTROLLER
Name	:	CONNIE WINBAUER
Credential	:
Telephone Number	:	763-862-5436

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	02/12/2008

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