Provider Demographics
NPI:1083933642
Name:ORTHOPEDIC SURGICAL CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGICAL CONSULTANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D., OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-428-3399
Mailing Address - Street 1:1601 SAINT FRANCIS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3383
Mailing Address - Country:US
Mailing Address - Phone:952-428-3399
Mailing Address - Fax:952-428-3390
Practice Address - Street 1:3000 N CHESTNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-3054
Practice Address - Country:US
Practice Address - Phone:952-428-3399
Practice Address - Fax:952-428-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1123332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN826312400Medicaid
MN826312400Medicaid