MEDICARE: MN STATE COLLEGES AND UNIVERSITIES

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	261QS1000X	Student Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17278MA	OTHER	MN	BLUECROSS BLUESHIELD
2	167195	OTHER	MN	UCARE

General Provider Information

NPI Number	:	1386629368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MN STATE COLLEGES AND UNIVERSITIES

Provider Business Mailing Address
First Line	:	600 MAYWOOD AVE
Second Line	:	21 CARKOSKI COMMONS
City	:	MANKATO
State	:	MN
Zip	:	56001-7008
Country	:	US
Telephone Number	:	507-389-6276
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 MAYWOOD AVE
Second Line	:	21 CARKOSKI COMMONS
City	:	MANKATO
State	:	MN
Zip	:	56001-7008
Country	:	US
Telephone Number	:	507-389-6276
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHRISTINE CONNOLLY
Credential	:
Telephone Number	:	507-389-5689

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	08/22/2020

Similar Medicare Providers

1619961216 — JODI ANN EGELAND MSN, CNP
Practice Location Address:

600 MAYWOOD AVE
MANKATO, MN
56001-7008

Practice Phone: 507-389-6276
Practice Fax: 507-389-5787

1912989732 — JEANNE M STEIL RPH
Practice Location Address:

600 MAYWOOD AVE , 21 CARKOSKI COMMONS
MANKATO, MN
56001-7008

Practice Phone: 507-389-2483
Practice Fax: 507-389-2206

1184606667 — MARYPAT OLSETH ANDERSON M.D.
Practice Location Address:

600 MAYWOOD AVE , 21 CARKOSKI COMMONS
MANKATO, MN
56001-7008

Practice Phone: 507-389-6276
Practice Fax: 507-389-5787

1952383465 — ANN MARIE JOHNSON RPH
Practice Location Address:

600 MAYWOOD AVE , 21 CARKOSKI COMMONS
MANKATO, MN
56001-7008

Practice Phone: 507-389-2483
Practice Fax: 507-389-2206

1437255296 — PAULINE MARION GENTER R.D.
Practice Location Address:

600 MAYWOOD AVE , CC100
MANKATO, MN
56001-7008

Practice Phone: 507-389-6203
Practice Fax: 507-389-5787

1427811868 — MELANIE MOORE RPH
Practice Location Address:

600 MAYWOOD AVE # CC21
MANKATO, MN
56001-7008

Practice Phone: 507-389-2483
Practice Fax: 507-389-2206

Directions to “MN STATE COLLEGES AND UNIVERSITIES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.