Healthcare Provider Details

I. General information

NPI: 1740252634
Provider Name (Legal Business Name): MINNEAPOLIS ENDOSCOPY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 PARKLAWN SOUTH SUITE 108
EDINA MN
55435
US

IV. Provider business mailing address

7600 PARKLAWN SOUTH SUITE 108
EDINA MN
55435
US

V. Phone/Fax

Practice location:
  • Phone: 612-870-5750
  • Fax: 612-870-5732
Mailing address:
  • Phone: 612-870-5750
  • Fax: 612-870-5732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number331034
License Number StateMN

VIII. Authorized Official

Name: MR. CHRISTOPHER A HOLDEN
Title or Position: CHIEF MANAGER OF LLC
Credential:
Phone: 615-665-1283