Healthcare Provider Details

I. General information

NPI: 1053314013
Provider Name (Legal Business Name): TRIA ORTHOPAEDIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 NORTHLAND DR
MINNEAPOLIS MN
55431-4800
US

IV. Provider business mailing address

8100 NORTHLAND DR
MINNEAPOLIS MN
55431-4800
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-8742
  • Fax: 952-831-1626
Mailing address:
  • Phone: 952-831-8742
  • Fax: 952-831-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number328557
License Number StateMN

VIII. Authorized Official

Name: JASON J LUHRS
Title or Position: VP FINANCE
Credential:
Phone: 952-883-7158