Provider Demographics
NPI: | 1306189642 |
---|---|
Name: | SUMMIT ORTHOPEDICS, LTD |
Entity type: | Organization |
Organization Name: | SUMMIT ORTHOPEDICS, LTD |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BIEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 651-968-5870 |
Mailing Address - Street 1: | 710 COMMERCE DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | WOODBURY |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55125-4925 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 651-968-5201 |
Mailing Address - Fax: | 651-968-5904 |
Practice Address - Street 1: | 14655 GALAXIE AVE |
Practice Address - Street 2: | |
Practice Address - City: | APPLE VALLEY |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55124-8575 |
Practice Address - Country: | US |
Practice Address - Phone: | 651-968-5201 |
Practice Address - Fax: | 651-968-5904 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-04-05 |
Last Update Date: | 2025-06-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 1463 | 332B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty |