Healthcare Provider Details

I. General information

NPI: 1083885081
Provider Name (Legal Business Name): CHU SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9117 LYNDALE AVE S
BLOOMINGTON MN
55420-3522
US

IV. Provider business mailing address

9117 LYNDALE AVE S
BLOOMINGTON MN
55420-3522
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-1235
  • Fax: 952-835-1092
Mailing address:
  • Phone: 952-835-1235
  • Fax: 952-835-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CARRIE JEAN JACOBS
Title or Position: ADMINISTRATOR
Credential:
Phone: 952-835-0965