# NORTH MEMORIAL ENDOSCOPY CENTER AT MAPLE GROVE, LLC

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

## Provider details

- **NPI number:** 1720274467
- **Authorized official:** DR. GREG MEVISSEN M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (763) 981-3200

## Contact information

- **Practice address:** 9855 HOSPITAL DR, SUITE 275, MAPLE GROVE, MN 55369-4778
- **Practice address phone:** (763) 981-3200
- **Mailing address:** 9855 HOSPITAL DR, SUITE 275, MAPLE GROVE, MN 55369-4778

## Taxonomy

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

## Other

- **Enumeration date:** 09/17/2007
- **Last updated:** 06/21/2018