1346389251 NPI number — ORTHOPEDIC SURGICAL CONSULTANTS, P.A.

Table of content: (NPI 1346389251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346389251 NPI number — ORTHOPEDIC SURGICAL CONSULTANTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC 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:
1346389251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2854 HIGHWAY 55
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
EAGAN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55121-2156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-842-3367
Provider Business Mailing Address Fax Number:
651-224-5273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 SAINT FRANCIS AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SHAKOPEE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55379-3373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-403-3399
Provider Business Practice Location Address Fax Number:
952-403-3390
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PA-C, OFFICE MANAGER
Authorized Official Telephone Number:
952-403-3399

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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