Provider Demographics
NPI:1003485004
Name:UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC
Entity Type:Organization
Organization Name:UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC
Other - Org Name:UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER - ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLRUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-884-0834
Mailing Address - Street 1:PO BOX 860493
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0493
Mailing Address - Country:US
Mailing Address - Phone:786-378-2640
Mailing Address - Fax:
Practice Address - Street 1:909 FULTON ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-4800
Practice Address - Country:US
Practice Address - Phone:612-273-8383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-23
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty