Healthcare Provider Details

I. General information

NPI: 1720210099
Provider Name (Legal Business Name): WINONA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 MANKATO AVE
WINONA MN
55987-4868
US

IV. Provider business mailing address

855 MANKATO AVE PO BOX 5600
WINONA MN
55987-4868
US

V. Phone/Fax

Practice location:
  • Phone: 507-457-4321
  • Fax: 507-474-3224
Mailing address:
  • Phone: 507-457-4321
  • Fax: 507-474-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number331049
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number350478
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number350478
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number347609
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number350478
License Number StateMN

VIII. Authorized Official

Name: JAN BROSNAHAN
Title or Position: CFO
Credential:
Phone: 507-454-3650