Provider Demographics
NPI:1992763932
Name:HEALTHEAST SURGERY CENTER-MAPLEWOOD, LLC
Entity type:Organization
Organization Name:HEALTHEAST SURGERY CENTER-MAPLEWOOD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-518-5185
Mailing Address - Street 1:2945 HAZELWOOD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1244
Mailing Address - Country:US
Mailing Address - Phone:651-471-9701
Mailing Address - Fax:651-471-9766
Practice Address - Street 1:2945 HAZELWOOD ST STE 300
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1244
Practice Address - Country:US
Practice Address - Phone:651-471-9701
Practice Address - Fax:651-471-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330892261QA1903X
MN356445261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical