Provider Demographics
NPI:1629130521
Name:MIDWEST SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MIDWEST SURGERY CENTER, LLC
Other - Org Name:MIDWEST SURGERY CENTER- WOODBURY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-642-9199
Mailing Address - Street 1:2080 WOODWINDS DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2523
Mailing Address - Country:US
Mailing Address - Phone:651-642-1106
Mailing Address - Fax:651-642-9837
Practice Address - Street 1:2080 WOODWINDS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2523
Practice Address - Country:US
Practice Address - Phone:651-642-1106
Practice Address - Fax:651-642-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN416712100OtherMEDICAL ASSISTANCE
MN62804MIOtherBCBS CRNA
MN108281OtherUCARE
MN0T542MIOtherBLUE CROSS BLUE SHIELD OF MN
MN490000006Medicare ID - Type Unspecified