Organization
NORTH MEMORIAL ENDOSCOPY CENTER AT MAPLE GROVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREG MEVISSEN M.D. (MEDICAL DIRECTOR)
(763) 981-3200
Entity
Organization
Contact information
Practice address
9855 HOSPITAL DR, SUITE 275, MAPLE GROVE, MN 55369-4778
(763) 981-3200
Mailing address
9855 HOSPITAL DR, SUITE 275, MAPLE GROVE, MN 55369-4778
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053443
PREFERRED ONE
—
01
—
1720274467
UCARE
MN
01
—
227634
HEALTH PARTNERS
—
05
—
48004500
—
MN
01
—
5T42MA
BSMN
MN
01
—
68-00093
SELECTCARE
—
Enumeration date
09/17/2007
Last updated
06/21/2018
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