MEDICARE: STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGET

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	314000000X	Skilled Nursing Facility	00531	MN

General Provider Information

NPI Number	:	1609217900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF MINNESOTA - MINNESOTA MANAGEMENT AND BUDGET

Provider Business Mailing Address
First Line	:	5101 MINNEHAHA AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-1647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 N PARK ST
Second Line	:
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-1247
Country	:	US
Telephone Number	:	218-226-6300
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SCOTT BUCHANAN
Credential	:
Telephone Number	:	218-736-0400

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	10/05/2017

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