Provider Demographics
NPI:1366949141
Name:MINNESOTA STATE COLLEGE AND UNIVERSITIES
Entity type:Organization
Organization Name:MINNESOTA STATE COLLEGE AND UNIVERSITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FOR FINANCE & ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:STRAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPA (EXECUTIVE)
Authorized Official - Phone:507-389-6621
Mailing Address - Street 1:135 MYERS FIELD HOUSE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-389-5461
Mailing Address - Fax:507-389-5352
Practice Address - Street 1:135 MYERS FIELD HOUSE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-389-5461
Practice Address - Fax:507-389-5352
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNESOTA STATE COLLEGES AND UNIVERSITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty