Healthcare Provider Details

I. General information

NPI: 1265303382
Provider Name (Legal Business Name): MAPLE GROVE CHILDREN'S SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 SLOAN PL STE 30
MAPLEWOOD MN
55117-2051
US

IV. Provider business mailing address

1997 SLOAN PL STE 30
MAPLEWOOD MN
55117-2051
US

V. Phone/Fax

Practice location:
  • Phone: 651-383-3333
  • Fax:
Mailing address:
  • Phone: 651-383-3333
  • 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: JEFFREY WHEELER
Title or Position: CEO
Credential:
Phone: 301-494-3000