# ST. CLOUD EAR, NOSE & THROAT - SURGICAL SUITES LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417188830
- **Authorized official:** MR. LARRY R BOLLER RRT, MBA (ADMINISTRATOR)
- **Authorized official phone:** (320) 252-0233

## Contact information

- **Practice address:** 1528 NORTHWAY DR, SAINT CLOUD, MN 56303-1255
- **Practice address phone:** (320) 252-0233
- **Practice address fax:** (320) 257-1126
- **Mailing address:** 1528 NORTHWAY DR, SAINT CLOUD, MN 56303-1255
- **Mailing address phone:** (320) 252-0233
- **Mailing address fax:** (320) 252-1421

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | PENDING | NULL | Yes |

## Other

- **Enumeration date:** 08/03/2009
- **Last updated:** 08/03/2009