Healthcare Provider Details

I. General information

NPI: 1568858652
Provider Name (Legal Business Name): ST. CLOUD OUTPATIENT SURGERY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
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: 320-251-8385
  • 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 M. FIELDS
Title or Position: VP
Credential:
Phone: 205-545-2572