Provider Demographics
NPI:1114047230
Name:LASER & SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:LASER & SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-293-8242
Mailing Address - Street 1:4344 20TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4434
Mailing Address - Country:US
Mailing Address - Phone:701-293-8242
Mailing Address - Fax:701-293-0909
Practice Address - Street 1:4344 20TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4434
Practice Address - Country:US
Practice Address - Phone:701-293-8242
Practice Address - Fax:701-293-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND6800026OtherMEDICA
MN634794110Medicaid
ND1114047230OtherRAILROAD MEDICARE
ND11661Medicaid
MN2C12LAOtherMN BS
MN2C12LAOtherMN BS