Healthcare Provider Details

I. General information

NPI: 1447235031
Provider Name (Legal Business Name): ST CLOUD AREA SURGERY CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ABBOTT NORTHWESTERN CT SUITE 305
SARTELL MN
56377-4202
US

IV. Provider business mailing address

2000 ABBOTT NORTHWESTERN CT SUITE 305
SARTELL MN
56377-4202
US

V. Phone/Fax

Practice location:
  • Phone: 320-534-2200
  • Fax: 320-534-2204
Mailing address:
  • Phone: 320-534-2200
  • Fax: 320-534-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBRA A RUDQUIST
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential: RN MS
Phone: 612-863-4716