Upper Mississippi Surgical Associates PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

34195 Issued in MN

Legal business name

UPPER MISSISSIPPI SURGICAL ASSOCIATES PA

Practice address

9264 Highway 115
Randall, MN 56475-2501

Phone

(320) 749-2607

Fax

(320) 749-8301

NPI assigned

Oct 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. George M.a. Fortier IV, M.D.

Title

President/Owner

Phone

(320) 749-2607

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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

• Noel David Collis, M.D.

  • Adolescent Medicine (Internal Medicine) Physician
  • Little Falls, MN
  • NPI 1912076720
  NPD (past)
• Sharon Elaine Gossett, MD

  • Surgery Physician
  • Moose Lake, MN
  • NPI 1336192293
  NPD (past)
• Kristofer Michael Wallman, MPAS, PA-C

  • Medical Physician Assistant
  • Foley, MN
  • NPI 1962439547
  NPD (past)

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193356800000",
    "number": "1285821314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9264 HIGHWAY 115",
            "city": "RANDALL",
            "state": "MN",
            "postal_code": "564752501",
            "telephone_number": "320-749-2607",
            "fax_number": "320-749-8301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9264 HIGHWAY 115",
            "city": "RANDALL",
            "state": "MN",
            "postal_code": "564752501",
            "telephone_number": "320-749-2607",
            "fax_number": "320-749-8301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER MISSISSIPPI SURGICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2007-10-26",
        "status": "A",
        "authorized_official_last_name": "FORTIER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "M.A.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "320-749-2607",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MN",
            "license": "34195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amazing Love Elderly Care Center LLC
• Tommie Dick Nuesse, MSW, LGSW
• Unity Family Healthcare (Randall Lakes Area Clinic)

• Specialist in Randall, MN
• Providers in Randall, MN by specialty
• Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; 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.