Itasca Surgical Clinic, PA

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

ITASCA SURGICAL CLINIC, PA

Practice address

1542 Golf Course Rd
Suite 202
Grand Rapids, MN 55744-9603

Phone

(218) 327-7973

Fax

(218) 327-3245

NPI assigned

May 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Daniel Margo, M.D.

Title

Owner

Phone

(218) 327-7973

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan James Davis, D,C,

  • Chiropractor
  • Grand Rapids, MN
  • NPI 1851408033
  NPD (past)
• John Anthony Joki

  • Chiropractor
  • Grand Rapids, MN
  • NPI 1235626656
  NPD (past)
• Todd Davis Newman, D.C.

  • Chiropractor
  • Cohasset, MN
  • NPI 1760525612
  NPD (past)
• Sandra Wallace Kunz, DOM

  • Acupuncturist
  • Maynard, MA
  • NPI 1699262642
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247097600000",
    "number": "1245288984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3920 13TH AVE E",
            "address_2": "SUITE 6",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557463675",
            "telephone_number": "218-263-7540",
            "fax_number": "866-732-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1542 GOLF COURSE RD",
            "address_2": "SUITE 202",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557449603",
            "telephone_number": "218-327-7973",
            "fax_number": "218-327-3245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ITASCA SURGICAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2009-07-09",
        "status": "A",
        "authorized_official_last_name": "MARGO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-327-7973",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "448327800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "97B18IT",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ind School District 318
• Itasca Chiropractic Center, P.C.
• Itasca County Family Young Men'S Christian Association, Inc.
• Itasca Nursing Home
• Itasca Psychiatric Services Inc
• J & L Urevig Inc
• J Hill Psychological Services L.L.C
• Brittany Jacobson
• Lana Rae Jacobson, FAMILY NURSE PRACTIT
• James Rostvold

• Specialist in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.