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General NPI Number Information
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NPI Number | 1609204197
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Entity Type | Organization
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Legal Business Name | MARSHALL SURGERY CENTER LLC
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 1521 CARLSON STREET SUITE 200
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City | MARSHALL
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State | MN
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Zip | 56258-1934
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Country | US
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Telephone | 507-532-1901
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Fax | 507-476-4801
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Provider Business Mailing Address
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Address Line | 1521 CARLSON STREET SUITE 200
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City | MARSHALL
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State | MN
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Zip | 56258-1934
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Country | US
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Telephone | 507-532-1901
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Fax | 507-476-4801
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD L HOLMGREN
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Credential | MD
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Telephone | 320-231-5053
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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 | MN
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