Provider Demographics
NPI:1730361478
Name:MIDWEST SURGERY CENTER
Entity type:Organization
Organization Name:MIDWEST SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:H. JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DRANNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-714-6904
Mailing Address - Street 1:2080 WOODBURY DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-642-1106
Mailing Address - Fax:
Practice Address - Street 1:2080 WOODWINDS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2523
Practice Address - Country:US
Practice Address - Phone:651-642-1106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNHE-01084-04367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty