Provider Demographics
NPI:1477604320
Name:SUMMIT ORTHOPEDICS, LTD
Entity Type:Organization
Organization Name:SUMMIT ORTHOPEDICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-968-5870
Mailing Address - Street 1:710 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4919
Mailing Address - Country:US
Mailing Address - Phone:651-968-5201
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:1661 SAINT ANTHONY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-968-5335
Practice Address - Fax:651-842-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0820180018Medicare NSC