Healthcare Provider Details

I. General information

NPI: 1811973639
Provider Name (Legal Business Name): SUMMIT ORTHOPEDICS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 TAMARACK RD STE 200
WOODBURY MN
55125-1208
US

IV. Provider business mailing address

710 COMMERCE DR STE 200
WOODBURY MN
55125-4925
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5468
  • Fax: 651-968-5492
Mailing address:
  • Phone: 651-968-5201
  • Fax: 651-730-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number375355
License Number StateMN

VIII. Authorized Official

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