Maple Grove Center for Restorative Surgery

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

MAPLE GROVE CENTER FOR RESTORATIVE SURGERY

Practice address

13601 80TH Circle North
Suite 100
Maple Grove, MN 55369

Phone

(763) 432-7655

Fax

(763) 432-7501

NPI assigned

Dec 17, 2019

Last updated

Oct 28, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Daniel Hanson

Title

Medical Director

Phone

(651) 324-8693

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1576540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1518505809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13601 80TH CIRCLE NORTH",
            "address_2": "SUITE 100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-432-7655",
            "fax_number": "763-432-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13601 80TH CIRCLE NORTH",
            "address_2": "SUITE 100",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "55369",
            "telephone_number": "763-432-7655",
            "fax_number": "763-432-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE GROVE CENTER FOR RESTORATIVE SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-17",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "651-324-8693"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Mark Mammel, MD
• Manasseh Home Healthcare LLC
• Michelle Lynn Mandler
• Roger L Mann
• Dianne Marie Mansfield, PT
• Maple Grove Center for Restorative Surgery LLC
• Maple Grove Counseling Center PA
• Maple Grove Dialysis LLC (Maple Grove Dialysis Unit)
• Maple Grove Eye Care, LLC
• Maple Grove Family Dental Clinic, PA

• Ambulatory Surgical Clinic/Center in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Ambulatory Surgical Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.