Organization
FAMILY SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARMEN MACIK (ADMINISTRATOR)
(320) 214-5759
Entity
Organization
Contact information
Practice address
1801 19TH AVE SW, WILLMAR, MN 56201-4946
(320) 235-7700
(320) 235-7701
Mailing address
1801 19TH AVE SW, WILLMAR, MN 56201-4946
(320) 235-7700
(320) 235-7701
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
330845
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
277A0FA
BCBS
MN
Enumeration date
10/18/2006
Last updated
06/12/2012
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