Provider Demographics
NPI:1134527880
Name:WAYZATA SURGERY CENTER
Entity type:Organization
Organization Name:WAYZATA SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-559-4500
Mailing Address - Street 1:935 WAYZATA BLVD E STE 101
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1849
Mailing Address - Country:US
Mailing Address - Phone:763-559-4500
Mailing Address - Fax:763-559-1733
Practice Address - Street 1:935 WAYZATA BLVD E STE 101
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1849
Practice Address - Country:US
Practice Address - Phone:763-559-4500
Practice Address - Fax:763-559-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN369743261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical