MEDICARE: SOUTHEAST MINNESOTA SPORTS MEDICINE & ORTHOPAEDIC SURGERY SPECIALISTS

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	174400000X	Specialist	1662	MN

General Provider Information

NPI Number	:	1558326942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST MINNESOTA SPORTS MEDICINE & ORTHOPAEDIC SURGERY SPECIALISTS

Provider Business Mailing Address
First Line	:	111 RIVERFRONT
Second Line	:	STE 307
City	:	WINONA
State	:	MN
Zip	:	55987-3456
Country	:	US
Telephone Number	:	507-474-9300
Fax Number	:	507-474-9302

Provider Business Practice Location Address
First Line	:	111 RIVERFRONT
Second Line	:	STE 307
City	:	WINONA
State	:	MN
Zip	:	55987-3456
Country	:	US
Telephone Number	:	507-474-9300
Fax Number	:	507-474-9302

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD L ROMEYN
Credential	:	M.D.
Telephone Number	:	507-474-9300

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	05/04/2011

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