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General NPI Number Information
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NPI Number | 1922059013
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Entity Type | Organization
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Legal Business Name | CENTRAL MINNESOTA ANESTHESIA, LTD
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1526 NORTHWAY DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1255
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Country | US
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Telephone | 320-251-8385
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Fax |
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Provider Business Mailing Address
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Address Line | 14700 28TH AVE N SUITE 20
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City | PLYMOUTH
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State | MN
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Zip | 55447-4835
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Country | US
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Telephone | 763-559-3779
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Fax | 763-450-3986
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY L JOHNSON
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Credential | M.D.
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Telephone | 320-251-8385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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