Healthcare Provider Details

I. General information

NPI: 1558326942
Provider Name (Legal Business Name): SOUTHEAST MINNESOTA SPORTS MEDICINE & ORTHOPAEDIC SURGERY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 RIVERFRONT STE 307
WINONA MN
55987-3456
US

IV. Provider business mailing address

111 RIVERFRONT STE 307
WINONA MN
55987-3456
US

V. Phone/Fax

Practice location:
  • Phone: 507-474-9300
  • Fax: 507-474-9302
Mailing address:
  • Phone: 507-474-9300
  • Fax: 507-474-9302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1662
License Number StateMN

VIII. Authorized Official

Name: DR. RICHARD L ROMEYN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 507-474-9300