Provider Demographics
NPI:1194751552
Name:SPORTS AND ORTHOPAEDIC SPECIALISTS, PA
Entity type:Organization
Organization Name:SPORTS AND ORTHOPAEDIC SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-946-9777
Mailing Address - Street 1:8100 W 78TH ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2516
Mailing Address - Country:US
Mailing Address - Phone:952-946-9777
Mailing Address - Fax:952-946-9888
Practice Address - Street 1:8100 W 78TH ST
Practice Address - Street 2:SUITE 225
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2516
Practice Address - Country:US
Practice Address - Phone:952-946-9777
Practice Address - Fax:952-946-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59836OtherHEALTHPARTNERS
MN3420AOtherSELECT CARE
MNCI4045OtherRAILROAD MEDICARE
MN89704OtherPERFERRED ONE
MN60D44SHOtherBLUE CROSS/SHIELD
MNCI4045OtherRAILROAD MEDICARE
MN60D44SHOtherBLUE CROSS/SHIELD