Healthcare Provider Details

I. General information

NPI: 1154308880
Provider Name (Legal Business Name): WOODBURY AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8675 VALLEY CREEK RD STE 300
WOODBURY MN
55125-2337
US

IV. Provider business mailing address

8675 VALLEY CREEK RD STE 300
WOODBURY MN
55125-2337
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-3450
  • Fax: 651-241-3453
Mailing address:
  • Phone: 651-241-3450
  • Fax: 651-241-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number375356
License Number StateMN

VIII. Authorized Official

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