NPI: 1417346719

MH 101, PC

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• Entity Type: Organization
• Last Observed in the System¹ on:
• First Entered in the System¹ on: 2015-01-10
• Medicare Revalidation Due Date²: Not Available
• Certified the records on: Not Certified
• Parent Organization: MH 101, PC
• NPPES Profile Page: https://npiregistry.cms.hhs.gov/provider-view/1417346719
• CMS Profile Page: https://data.cms.gov/tools/medicare-physician-other-practitioner-look-up-tool/provider/1417346719

Other Names

• 2018-07-08 ~ 2024-09-08 , Other Name, MH 101 at Lake Region Chaska

Addresses

• Primary & Current, 340 LAKE HAZELTINE DR C/O LAKE REGION EMPLOYEE HEALTH CENTER, CHASKA, MN 553181034

Taxonomies

• 2018-01-07 ~ Present ³ , Physician Assistant (363A00000X), Primary

Notes

1. https://nppes.cms.hhs.gov/#/
2. https://data.cms.gov/tools/medicare-revalidation-list
3. Our records go back to 2018-01-07, and any records preceding this date are not captured. Please regard 2018-01-07 as the earliest date we could verify the records back then, not as the actual date for the time range.
4. https://openpaymentsdata.cms.gov/
5. The information is based on the UnitedHealthcare Transparency in Coverage site.