Organization
MIDWEST STONE MANAGEMENT
Active
Other names
Midwest Stone
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLIE NYSTROM (COO)
(651) 633-9414
Entity
Organization
Contact information
Practice address
1885 COUNTY ROAD C W, ROSEVILLE, MN 55113-1304
(651) 633-9414
Mailing address
1885 COUNTY ROAD C W, ROSEVILLE, MN 55113-1304
Taxonomy
Speciality
Code
Description
License number
State
261QL0400X
Lithotripsy Clinic/Center
Primary
—
—
Other
Enumeration date
10/24/2006
Last updated
08/22/2020
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