1366479651 NPI number — SURGICAL CONSULTANTS, P.A.

Table of content: (NPI 1366479651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366479651 NPI number — SURGICAL CONSULTANTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL CONSULTANTS, P.A.
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:
Provider Other Organization Name Type Code:
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:
1366479651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4570 W 77TH ST
Provider Second Line Business Mailing Address:
SUITE 235
Provider Business Mailing Address City Name:
EDINA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55435-5008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-832-0805
Provider Business Mailing Address Fax Number:
952-832-5597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6405 FRANCE AVE S
Provider Second Line Business Practice Location Address:
SUITE W440
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435-2163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-927-7004
Provider Business Practice Location Address Fax Number:
952-927-5146
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROLAND
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
952-927-7004

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 189508700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com