Healthcare Provider Details

I. General information

NPI: 1124052436
Provider Name (Legal Business Name): MANKATO ANESTHESIA ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E MADISON AVE STE 311
MANKATO MN
56001-5473
US

IV. Provider business mailing address

PO BOX 4278
MANKATO MN
56002-4278
US

V. Phone/Fax

Practice location:
  • Phone: 507-387-8980
  • Fax: 507-387-8985
Mailing address:
  • Phone: 507-387-8980
  • Fax: 507-387-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DAVID J EGLI
Title or Position: PRESIDENT
Credential: MD
Phone: 507-387-8980