Healthcare Provider Details

I. General information

NPI: 1871257071
Provider Name (Legal Business Name): SOUTHDALE SPECIALTY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 BARRIE RD STE 300
EDINA MN
55435-2348
US

IV. Provider business mailing address

1457 WHITE OAK DR
CHASKA MN
55318-2525
US

V. Phone/Fax

Practice location:
  • Phone: 952-368-3800
  • Fax: 952-368-3801
Mailing address:
  • Phone: 952-368-3800
  • Fax: 952-368-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARA CONSULTANTS BHATTI
Title or Position: PRACTICE ADMINISTRATOR
Credential: RN
Phone: 952-368-3800