Healthcare Provider Details

I. General information

NPI: 1053135434
Provider Name (Legal Business Name): ESSENTIA HEALTH SURGERY CENTERS-MINNESOTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 GOLF COURSE RD STE 105
GRAND RAPIDS MN
55744-3553
US

IV. Provider business mailing address

1542 GOLF COURSE RD STE 105
GRAND RAPIDS MN
55744-3553
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3937
  • Fax:
Mailing address:
  • Phone: 218-326-3937
  • Fax:

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: BRADLEY BEARD
Title or Position: COO
Credential:
Phone: 218-786-2643