Provider Demographics
NPI:1548219397
Name:MINNESOTA ORTHOPAEDIC SURGERY CENTER LLC
Entity type:Organization
Organization Name:MINNESOTA ORTHOPAEDIC SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-786-9543
Mailing Address - Street 1:8290 UNIVERSITY AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1847
Mailing Address - Country:US
Mailing Address - Phone:763-786-0461
Mailing Address - Fax:763-786-0471
Practice Address - Street 1:8290 UNIVERSITY AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1847
Practice Address - Country:US
Practice Address - Phone:763-786-0461
Practice Address - Fax:763-786-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7Y16MIOtherBLUE CROSS/BLUE SHIELD
MN1021808OtherPREFERRED ONE
MN726170500Medicaid
MN7Y16MIOtherBLUE CROSS/BLUE SHIELD
MN1021808OtherPREFERRED ONE