Provider Demographics
NPI:1053314013
Name:TRIA ORTHOPAEDIC CENTER LLC
Entity Type:Organization
Organization Name:TRIA ORTHOPAEDIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUHRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-883-7158
Mailing Address - Street 1:8100 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55431-4800
Mailing Address - Country:US
Mailing Address - Phone:952-831-8742
Mailing Address - Fax:952-831-1626
Practice Address - Street 1:8100 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55431-4800
Practice Address - Country:US
Practice Address - Phone:952-831-8742
Practice Address - Fax:952-831-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328557261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN981410800Medicaid
MN981410800Medicaid