Healthcare Provider Details

I. General information

NPI: 1124084843
Provider Name (Legal Business Name): ST CLOUD OUTPATIENT SURGERY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 NORTHWAY DR
SAINT CLOUD MN
56303-1255
US

IV. Provider business mailing address

1526 NORTHWAY DR
SAINT CLOUD MN
56303-1255
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-8385
  • Fax:
Mailing address:
  • Phone:
  • 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: MS. DARCI NAGORSKI
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 320-251-8385