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General NPI Number Information
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NPI Number | 1720274467
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Entity Type | Organization
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Legal Business Name | NORTH MEMORIAL ENDOSCOPY CENTER AT MAPLE GROVE, LLC
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Dates
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Enumeration Date | 09/17/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 9855 HOSPITAL DR SUITE 275
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4778
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Country | US
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Telephone | 763-981-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 9855 HOSPITAL DR SUITE 275
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City | MAPLE GROVE
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State | MN
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Zip | 55369-4778
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GREG MEVISSEN
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Credential | M.D.
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Telephone | 763-981-3200
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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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