Provider Demographics
NPI:1245207687
Name:CDI TWIN CITIES ASC LLC
Entity Type:Organization
Organization Name:CDI TWIN CITIES ASC LLC
Other - Org Name:RAYUS TWIN CITIES ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIAL ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-738-4441
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:NW 5008
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-5008
Mailing Address - Country:US
Mailing Address - Phone:952-542-8553
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:5775 WAYZATA BOULEVARD
Practice Address - Street 2:SUITE 190
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-546-5022
Practice Address - Fax:952-546-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN490000038Medicare PIN