MEDICARE: MINNESOTA VALLEY SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1558313544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINNESOTA VALLEY SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	1000 W 140TH ST STE 102
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4876
Country	:	US
Telephone Number	:	952-232-1110
Fax Number	:	952-232-1150

Provider Business Practice Location Address
First Line	:	1000 W 140TH ST STE 102
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4876
Country	:	US
Telephone Number	:	952-232-1110
Fax Number	:	952-232-1150

Authorized Official
Title or Position	:	BOARD CHAIR
Name	:	JASON S HOLM
Credential	:
Telephone Number	:	952-232-1110

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/17/2026

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