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Organization
SPORTS AND ORTHOPAEDIC SPECIALISTS, PA
Active
Organization
SPORTS AND ORTHOPAEDIC SPECIALISTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM EVANS (OPERATIONS MANAGER)
(952) 946-9777
Entity
Organization
Contact information
Practice address
8100 W 78TH ST, SUITE 225, EDINA, MN 55439-2516
(952) 946-9777
(952) 946-9888
Mailing address
8100 W 78TH ST, SUITE 225, EDINA, MN 55439-2516
(952) 946-9777
(952) 946-9888
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3420A
SELECT CARE
MN
01
—
59836
HEALTHPARTNERS
MN
01
—
60D44SH
BLUE CROSS/SHIELD
MN
01
—
89704
PERFERRED ONE
MN
01
—
CI4045
RAILROAD MEDICARE
MN
Enumeration date
06/25/2006
Last updated
08/22/2020
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