Organization
MINNESOTA ORTHOPAEDIC SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER D HOLMBERG M.D. (PRESIDENT)
(763) 786-9543
Entity
Organization
Contact information
Practice address
8290 UNIVERSITY AVE NE, SUITE 100, FRIDLEY, MN 55432-1847
(763) 786-0461
(763) 786-0471
Mailing address
8290 UNIVERSITY AVE NE, SUITE 100, FRIDLEY, MN 55432-1847
(763) 717-4105
(952) 456-7092
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
HFID#04305
MN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
726170500
—
MN
Enumeration date
05/11/2006
Last updated
08/03/2016
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