Organization
MEDPARK SPECIALIZED SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE HEITKAMP (DIRECTOR)
(701) 951-2022
Entity
Organization
Contact information
Practice address
4450 31ST AVE S STE 201, FARGO, ND 58104-4556
(701) 293-9829
Mailing address
4450 31ST AVE S STE 201, FARGO, ND 58104-4598
(701) 951-2020
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
01/17/2022
Last updated
03/24/2023
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