Healthcare Provider Details

I. General information

NPI: 1790108140
Provider Name (Legal Business Name): SUMMIT ORTHOPEDICS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 ARCADE ST STE 250
VADNAIS HEIGHTS MN
55127-7135
US

IV. Provider business mailing address

3580 ARCADE ST STE 250
VADNAIS HEIGHTS MN
55127-7135
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5790
  • Fax: 651-968-5792
Mailing address:
  • Phone: 651-968-5790
  • Fax: 651-968-5792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number374566
License Number StateMN

VIII. Authorized Official

Name: BECKIE HINES
Title or Position: DIRECTOR OF SURGERY CENTERS
Credential:
Phone: 651-968-5438