Basic Information
| Provider Information | |||||||||
| NPI: | 1851370779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORCUTT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8674 | ||||||||
| Address2: | MANKATO CLINIC LTD | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | MANKATO CLINIC @ MAIN STREET | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560028674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 44038 | MN | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | 44038 | MN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0571299 | 05 | IA | MEDICAID | 1722574 | 01 | MN | MEDICA | OTHER | HP33939 | 01 | MN | HEALTH PARTNERS | OTHER | 020050332 | 01 | RR MEDICARE | OTHER | 47D35OR | 01 | MN | BCBS | OTHER | NA2951028012 | 01 | MN | PREFERRED ONE | OTHER | 1650285 | 01 | MN | AMERICAS PPO | OTHER | 168467100 | 05 | MN | MEDICAID | 410849339 56001 C190 | 01 | CHAMPUS | OTHER |