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General NPI Number Information
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NPI Number | 1871257071
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Entity Type | Organization
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Legal Business Name | SOUTHDALE SPECIALTY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 6500 BARRIE RD STE 300
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City | EDINA
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State | MN
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Zip | 55435-2348
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Country | US
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Telephone | 952-368-3800
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Fax | 952-368-3801
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Provider Business Mailing Address
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Address Line | 1457 WHITE OAK DR
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City | CHASKA
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State | MN
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Zip | 55318-2525
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Country | US
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Telephone | 952-368-3800
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Fax | 952-368-3801
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. SARA CONSULTANTS BHATTI
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Credential | RN
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Telephone | 952-368-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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