MEDICARE: MARK MOGENSEN PA-C

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	363AM0700X	Medical Physician Assistant	001660	IA

General Provider Information

NPI Number	:	1881679900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MOGENSEN PA-C

Provider Business Mailing Address
First Line	:	460 N STATE RD
Second Line	:
City	:	LAKE VIEW
State	:	IA
Zip	:	51450-7307
Country	:	US
Telephone Number	:	712-830-3170
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 N STATE RD
Second Line	:
City	:	LAKE VIEW
State	:	IA
Zip	:	51450-7307
Country	:	US
Telephone Number	:	712-830-3170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	12/09/2025

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