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General NPI Number Information
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NPI Number | 1154718070
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Entity Type | Organization
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Legal Business Name | FERTILITY LAB SCIENCES OF MINNEAPOLIS, LLC
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 6565 FRANCE AVENUE SOUTH
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 720-205-4698
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 MT PYRAMID CT STE 400
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City | ENGLEWOOD
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State | CO
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Zip | 80112-2669
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Country | US
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Telephone | 720-205-4698
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DOUGLAS WERTZ
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Credential |
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Telephone | 720-205-4698
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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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