Healthcare Provider Details

I. General information

NPI: 1316130560
Provider Name (Legal Business Name): HODGES SURGICAL CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 HIGHWAY 55 SUITE #130
EAGAN MN
55121-2156
US

IV. Provider business mailing address

2854 HIGHWAY 55 SUITE #130
EAGAN MN
55121-2156
US

V. Phone/Fax

Practice location:
  • Phone: 651-842-3329
  • Fax:
Mailing address:
  • Phone: 651-842-3329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LEROY W HODGES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 651-224-4930