Provider Demographics
NPI:1215081468
Name:CHASKA MEDICAL CENTER
Entity type:Organization
Organization Name:CHASKA MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:REKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-0529
Mailing Address - Street 1:1335 10TH AVE EAST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379
Mailing Address - Country:US
Mailing Address - Phone:952-496-6700
Mailing Address - Fax:952-445-9446
Practice Address - Street 1:1335 10TH AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2901
Practice Address - Country:US
Practice Address - Phone:952-496-6700
Practice Address - Fax:952-445-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51172CHOtherBCBS
MNC7409Medicare ID - Type Unspecified