Provider Demographics
NPI:1235197526
Name:MINNESOTA ORTHOPAEDIC SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:MINNESOTA ORTHOPAEDIC SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:I
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-455-2013
Mailing Address - Street 1:701 25TH AVE S
Mailing Address - Street 2:SUITE 505
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1513
Mailing Address - Country:US
Mailing Address - Phone:612-455-2008
Mailing Address - Fax:612-455-2045
Practice Address - Street 1:701 25TH AVE S
Practice Address - Street 2:SUITE 505
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1513
Practice Address - Country:US
Practice Address - Phone:612-455-2008
Practice Address - Fax:612-455-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty