Provider Demographics
NPI:1366479651
Name:SURGICAL CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:SURGICAL CONSULTANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-927-7004
Mailing Address - Street 1:4570 W 77TH ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5008
Mailing Address - Country:US
Mailing Address - Phone:952-832-0805
Mailing Address - Fax:952-832-5597
Practice Address - Street 1:6405 FRANCE AVE S
Practice Address - Street 2:SUITE W440
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2163
Practice Address - Country:US
Practice Address - Phone:952-927-7004
Practice Address - Fax:952-927-5146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN189508700Medicaid
MN189508700Medicaid