Provider Demographics
NPI:1114057023
Name:CROSSROADS SURGERY CENTER INC
Entity Type:Organization
Organization Name:CROSSROADS SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:RICHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-332-9900
Mailing Address - Street 1:1575 20TH ST NW STE 203
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-2930
Mailing Address - Country:US
Mailing Address - Phone:507-332-9900
Mailing Address - Fax:507-332-6800
Practice Address - Street 1:1575 20TH ST NW STE 203
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-2930
Practice Address - Country:US
Practice Address - Phone:507-332-9900
Practice Address - Fax:507-332-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8598271261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN957902000Medicaid
MNP00411252OtherRAILROAD MEDICARE
MN490000065Medicare PIN