Provider Demographics
NPI:1871257071
Name:SOUTHDALE SPECIALTY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SOUTHDALE SPECIALTY SURGERY CENTER, LLC
Other - Org Name:BHATTI GI CONSULTANTS, P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:CONSULTANTS
Authorized Official - Last Name:BHATTI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-368-3800
Mailing Address - Street 1:1457 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2525
Mailing Address - Country:US
Mailing Address - Phone:952-368-3800
Mailing Address - Fax:952-368-3801
Practice Address - Street 1:6500 BARRIE RD STE 300
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2348
Practice Address - Country:US
Practice Address - Phone:952-368-3800
Practice Address - Fax:952-368-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty