Provider Demographics
NPI:1053135434
Name:ESSENTIA HEALTH SURGERY CENTERS-MINNESOTA LLC
Entity type:Organization
Organization Name:ESSENTIA HEALTH SURGERY CENTERS-MINNESOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-786-2652
Mailing Address - Street 1:1542 GOLF COURSE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3553
Mailing Address - Country:US
Mailing Address - Phone:218-326-3937
Mailing Address - Fax:
Practice Address - Street 1:1542 GOLF COURSE RD STE 105
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3553
Practice Address - Country:US
Practice Address - Phone:218-326-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical