Provider Demographics
NPI:1942265434
Name:SURGICAL SPECIALTIES, LTD.
Entity Type:Organization
Organization Name:SURGICAL SPECIALTIES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:JULSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-224-9350
Mailing Address - Street 1:470 W 78TH ST
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4539
Mailing Address - Country:US
Mailing Address - Phone:952-224-9350
Mailing Address - Fax:952-224-9356
Practice Address - Street 1:470 W 78TH ST
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4524
Practice Address - Country:US
Practice Address - Phone:952-224-9350
Practice Address - Fax:952-224-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC00250Medicare ID - Type Unspecified