Provider Demographics
NPI:1609204197
Name:MARSHALL SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MARSHALL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLMGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-231-5053
Mailing Address - Street 1:1521 CARLSON STREET SUITE 200
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1934
Mailing Address - Country:US
Mailing Address - Phone:507-532-1901
Mailing Address - Fax:507-476-4801
Practice Address - Street 1:1521 CARLSON STREET SUITE 200
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1934
Practice Address - Country:US
Practice Address - Phone:507-532-1901
Practice Address - Fax:507-476-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical