Provider Demographics
NPI:1861825986
Name:VADNAIS HEIGHTS SURGERY CENTER LLC
Entity Type:Organization
Organization Name:VADNAIS HEIGHTS SURGERY CENTER LLC
Other - Org Name:VADNAIS HEIGHTS SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-968-5333
Mailing Address - Street 1:3580 STREET STE 200
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7135
Mailing Address - Country:US
Mailing Address - Phone:651-968-5790
Mailing Address - Fax:651-968-5792
Practice Address - Street 1:3580 STREET STE 200
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-7135
Practice Address - Country:US
Practice Address - Phone:651-968-5790
Practice Address - Fax:651-968-5792
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT ORTHOPEDICS, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-13
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN375357261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical