Provider Demographics
NPI:1124052436
Name:MANKATO ANESTHESIA ASSOCIATES LTD
Entity type:Organization
Organization Name:MANKATO ANESTHESIA ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:EGLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-387-8980
Mailing Address - Street 1:PO BOX 4278
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-4278
Mailing Address - Country:US
Mailing Address - Phone:507-387-8980
Mailing Address - Fax:507-387-8985
Practice Address - Street 1:1400 E MADISON AVE
Practice Address - Street 2:STE 311
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5473
Practice Address - Country:US
Practice Address - Phone:507-387-8980
Practice Address - Fax:507-387-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN209708700Medicaid
41392MAOtherBLUE SHIELD OF MN
115401OtherUCARE
2972OtherHEALTH PARTNERS