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General NPI Number Information
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NPI Number | 1952329757
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Entity Type | Organization
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Legal Business Name | MIDSOTA SURGICAL SUITES PA
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 3701 12TH STREET N STE 101
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-253-7257
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Fax | 320-251-2938
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Provider Business Mailing Address
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Address Line | 3701 12TH STREET N STE 101
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City | ST CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-253-7257
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Fax | 320-251-2938
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ENNIS H ARNSTON
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Credential |
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Telephone | 320-253-7257
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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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