Provider Demographics
NPI:1952329757
Name:MIDSOTA SURGICAL SUITES PA
Entity Type:Organization
Organization Name:MIDSOTA SURGICAL SUITES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ENNIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:ARNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-253-7257
Mailing Address - Street 1:3701 12TH STREET N
Mailing Address - Street 2:STE 101
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-253-7257
Mailing Address - Fax:320-251-2938
Practice Address - Street 1:3701 12TH STREET N
Practice Address - Street 2:STE 101
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-253-7257
Practice Address - Fax:320-251-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA038585900OtherSCHULTZ PROVIDER #
54385HEOtherHEATH BCBS
111041OtherSMITH UCARE
1324451OtherHEATH MEDICA
532001OtherSMITH P ONE
532002OtherHEATH P ONE
53242MIOtherGROUP BCBS
1324439OtherSMITH MEDICA
MA192212200OtherGROUP PROVIDER #
MA474867100OtherHEATH PROVIDER #
MA594867300OtherSMITH PROVIDER #
07537OtherGROUP METRAHEALTH
249000020OtherHEATH METRAHEALTH
249000023OtherSMITH METRAHEALTH
56657SMOtherSMITH BCBS
108167OtherGROUP UCARE
111019OtherHEATH UCARE
MA038585900OtherSCHULTZ PROVIDER #
249000020OtherHEATH METRAHEALTH
D75688Medicare UPIN