Provider Demographics
NPI:1003272980
Name:PAIN CENTERS OF MINNESOTA - CHASKA, LLC
Entity Type:Organization
Organization Name:PAIN CENTERS OF MINNESOTA - CHASKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-492-7039
Mailing Address - Street 1:9645 GROVE CIR N STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-2684
Mailing Address - Country:US
Mailing Address - Phone:763-201-8191
Mailing Address - Fax:763-201-8192
Practice Address - Street 1:3000 HUNDERTMARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1150
Practice Address - Country:US
Practice Address - Phone:763-201-8191
Practice Address - Fax:763-201-8192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO SURGICAL CENTERS HOLDCO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-08
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical