Provider Demographics
NPI:1447235031
Name:ST CLOUD AREA SURGERY CTR
Entity Type:Organization
Organization Name:ST CLOUD AREA SURGERY CTR
Other - Org Name:CENTER FOR OUTPATIENT SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:RN MS
Authorized Official - Phone:612-863-4716
Mailing Address - Street 1:2000 ABBOTT NORTHWESTERN CT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4202
Mailing Address - Country:US
Mailing Address - Phone:320-534-2200
Mailing Address - Fax:320-534-2204
Practice Address - Street 1:2000 ABBOTT NORTHWESTERN CT
Practice Address - Street 2:SUITE 305
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4202
Practice Address - Country:US
Practice Address - Phone:320-534-2200
Practice Address - Fax:320-534-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Not Answered261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Not Answered261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain