Provider Demographics
NPI:1336538297
Name:MINNETONKA AMBULATORY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MINNETONKA AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-961-1863
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15450 HIGHWAY 7
Practice Address - Street 2:STE 200
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3522
Practice Address - Country:US
Practice Address - Phone:763-581-8950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
24C0001088OtherMEDICARE CCN