Healthcare Provider Details

I. General information

NPI: 1598430084
Provider Name (Legal Business Name): INSPIRED SPINE SURGCENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 FRANCE AVE S
EDINA MN
55435-4738
US

IV. Provider business mailing address

1601 HIGHWAY 13 E STE 211
BURNSVILLE MN
55337-5105
US

V. Phone/Fax

Practice location:
  • Phone: 952-405-9870
  • Fax:
Mailing address:
  • Phone: 952-405-9760
  • Fax: 855-430-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARYA C LYDEEN
Title or Position: SVP/PRACTICE ADMINISTRATOR
Credential:
Phone: 952-832-5252