Provider Demographics
NPI:1760435242
Name:WESTERN ORTHOPAEDIC SURGERY, LTD.
Entity Type:Organization
Organization Name:WESTERN ORTHOPAEDIC SURGERY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-694-2977
Mailing Address - Street 1:5100 GAMBLE DR
Mailing Address - Street 2:SUITE 540
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1521
Mailing Address - Country:US
Mailing Address - Phone:763-694-2977
Mailing Address - Fax:
Practice Address - Street 1:6490 EXCELSIOR BLVD
Practice Address - Street 2:W-417
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4705
Practice Address - Country:US
Practice Address - Phone:763-694-2977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN271210500Medicaid
MN0929927OtherMEDICA
MN03388DAOtherBLUE CROSS BLUE SHIELD MN
MNC808OtherUCARE
MN0929927OtherMEDICA