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General NPI Number Information
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NPI Number | 1811973639
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Entity Type | Organization
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Legal Business Name | SUMMIT ORTHOPEDICS LTD
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 7115 TAMARACK RD STE 200
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City | WOODBURY
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State | MN
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Zip | 55125-1208
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Country | US
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Telephone | 651-968-5468
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Fax | 651-968-5492
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Provider Business Mailing Address
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Address Line | 710 COMMERCE DR STE 200
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City | WOODBURY
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State | MN
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Zip | 55125-4925
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Country | US
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Telephone | 651-968-5201
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Fax | 651-730-3556
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Authorized Official
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Title or Position | DIRECTOR OF SURGERY CENTERS
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Name | BECKIE HINES
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Credential |
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Telephone | 651-968-5438
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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 | 375355
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License Number State | MN
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