Provider Demographics
NPI:1316133044
Name:NORTH MEMORIAL AMBULATORY SURGERY CENTER AT MAPLE GROVE, LLC
Entity type:Organization
Organization Name:NORTH MEMORIAL AMBULATORY SURGERY CENTER AT MAPLE GROVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-981-3200
Mailing Address - Street 1:9855 HOSPITAL DR
Mailing Address - Street 2:STE 175
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4772
Mailing Address - Country:US
Mailing Address - Phone:763-981-3200
Mailing Address - Fax:
Practice Address - Street 1:9855 HOSPITAL DR
Practice Address - Street 2:STE 175
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4772
Practice Address - Country:US
Practice Address - Phone:763-981-3200
Practice Address - Fax:763-981-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053442OtherPREFERRED ONE
MN1316133044OtherUCARE
227637OtherHEALTH PARTNERS
68-00092OtherPATIENT CHOICE
MN393688000Medicaid
68-00092OtherSELECTCARE
68-00092OtherLABORCARE
68-00092OtherMEDICA
MN5T43MAOtherBSMN
68-00092OtherMEDICA