Healthcare Provider Details

I. General information

NPI: 1023899234
Provider Name (Legal Business Name): NORTHWEST DAKOTA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 18TH AVENUE SE
MINOT ND
58701
US

IV. Provider business mailing address

2370 ANSELMO DR
CORONA CA
92879-7106
US

V. Phone/Fax

Practice location:
  • Phone: 714-234-6728
  • Fax:
Mailing address:
  • Phone: 714-234-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. SUZANNE HAWTHORN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 714-234-6728