Healthcare Provider Details

I. General information

NPI: 1245207687
Provider Name (Legal Business Name): CDI TWIN CITIES ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 WAYZATA BOULEVARD SUITE 190
ST LOUIS PARK MN
55416
US

IV. Provider business mailing address

PO BOX 1450 NW 5008
MINNEAPOLIS MN
55485-5008
US

V. Phone/Fax

Practice location:
  • Phone: 952-546-5022
  • Fax: 952-546-5024
Mailing address:
  • Phone: 952-542-8553
  • Fax: 952-513-6880

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: RAMONA AHERN
Title or Position: SPECIAL ASSISTANT SECRETARY
Credential:
Phone: 952-738-4441