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General NPI Number Information
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NPI Number | 1003272980
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Entity Type | Organization
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Legal Business Name | PAIN CENTERS OF MINNESOTA - CHASKA, LLC
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 3000 HUNDERTMARK RD SUITE 200
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City | CHASKA
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State | MN
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Zip | 55318-1150
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Country | US
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Telephone | 763-201-8191
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Fax | 763-201-8192
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Provider Business Mailing Address
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Address Line | 9645 GROVE CIR N STE 200
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City | MAPLE GROVE
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State | MN
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Zip | 55369-2684
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Country | US
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Telephone | 763-201-8191
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Fax | 763-201-8192
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Authorized Official
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Title or Position | OWNER
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Name | JASON WOLFF
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Credential | MD
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Telephone | 320-492-7039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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