Healthcare Provider Details

I. General information

NPI: 1861506263
Provider Name (Legal Business Name): CENTRAL MINNESOTA SURGEONS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 23RD STREET SOUTH, SUITE 300
SARTELL MN
56377-4768
US

IV. Provider business mailing address

2000 23RD STREET SOUTH, SUITE 300
SARTELL MN
56377-4768
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-5676
  • Fax: 320-251-0623
Mailing address:
  • Phone: 320-251-5676
  • Fax: 320-251-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DARREN ROBERT GLASS
Title or Position: PRESIDENT
Credential: MD
Phone: 320-251-5676