1013946276 NPI number — INSTITUTE OF SPECIALTY SURGERY LLC

Table of content: (NPI 1013946276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013946276 NPI number — INSTITUTE OF SPECIALTY SURGERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE OF SPECIALTY SURGERY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INSTITUTE FOR SPECIAL SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013946276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 25TH ST S
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58103-6104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-271-1045
Provider Business Mailing Address Fax Number:
701-271-1044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 25TH ST S
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-271-1045
Provider Business Practice Location Address Fax Number:
701-271-1044
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAUGEN
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
701-271-1045

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 395014000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10846 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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