Organization
UPPER MISSISSIPPI SURGICAL ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE M.A. FORTIER IV M.D. (PRESIDENT/OWNER)
(320) 749-2607
Entity
Organization
Contact information
Practice address
9264 HIGHWAY 115, RANDALL, MN 56475-2501
(320) 749-2607
(320) 749-8301
Mailing address
9264 HIGHWAY 115, RANDALL, MN 56475-2501
(320) 749-2607
(320) 749-8301
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
34195
MN
Other
Enumeration date
10/02/2007
Last updated
10/26/2007
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