# WAYZATA SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OMNI MEDICAL CENTER PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043812787
- **Legal business name:** OMNI MEDICAL CENTER PLLC
- **Authorized official:** JOHN A NESS MD (PRESIDENT)
- **Authorized official phone:** (763) 559-4500

## Contact information

- **Practice address:** 935 WAYZATA BLVD E STE 200, WAYZATA, MN 55391-2513
- **Practice address phone:** (763) 559-4500
- **Mailing address:** 935 WAYZATA BLVD E STE 200, WAYZATA, MN 55391-2513
- **Mailing address phone:** (763) 559-4500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | — |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | — |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | NULL | — |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | — | — | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/09/2020
- **Last updated:** 11/09/2020