Provider Demographics
NPI:1205970894
Name:ST. CROIX ORTHOPAEDICS, P.A.
Entity type:Organization
Organization Name:ST. CROIX ORTHOPAEDICS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ANCILLARY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-351-2728
Mailing Address - Street 1:5803 NEAL AVE N
Mailing Address - Street 2:
Mailing Address - City:OAK PARK HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55082-2177
Mailing Address - Country:US
Mailing Address - Phone:651-439-8807
Mailing Address - Fax:651-439-0232
Practice Address - Street 1:1715 TOWER DR. W SUITE 100
Practice Address - Street 2:HEARTLAND CENTER
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7609
Practice Address - Country:US
Practice Address - Phone:651-275-4180
Practice Address - Fax:651-275-2744
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CROIX ORTHOPAEDICS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41657800Medicaid
MN44582OtherHEALTHPARTNERS
MN8G895BROtherBLUE CROSS MN BLUE PLUS
MN9635801017818OtherPREFERRED ONE
MN942298600Medicaid
MN102957OtherUCARE
MN8G895BROtherBLUE CROSS MN BLUE PLUS