Organization
MIDSOTA SURGICAL SUITES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENNIS H ARNSTON (EXECUTIVE DIRECTOR)
(320) 253-7257
Entity
Organization
Contact information
Practice address
3701 12TH STREET N, STE 101, ST CLOUD, MN 56303
(320) 253-7257
(320) 251-2938
Mailing address
3701 12TH STREET N, STE 101, ST CLOUD, MN 56303
(320) 253-7257
(320) 251-2938
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038585900
SCHULTZ PROVIDER #
MA
01
—
07537
GROUP METRAHEALTH
—
01
—
108167
GROUP UCARE
—
01
—
111019
HEATH UCARE
—
01
—
111041
SMITH UCARE
—
01
—
1324439
SMITH MEDICA
—
01
—
1324451
HEATH MEDICA
—
01
—
192212200
GROUP PROVIDER #
MA
01
—
249000020
HEATH METRAHEALTH
—
01
—
249000023
SMITH METRAHEALTH
—
01
—
474867100
HEATH PROVIDER #
MA
01
—
532001
SMITH P ONE
—
01
—
532002
HEATH P ONE
—
01
—
53242MI
GROUP BCBS
—
01
—
54385HE
HEATH BCBS
—
01
—
56657SM
SMITH BCBS
—
01
—
594867300
SMITH PROVIDER #
MA
Enumeration date
07/18/2006
Last updated
02/25/2010
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