Blaine MN Multi Specialty ASC LLC
Organization Active NPI Ambulatory Surgical Clinic/Center · Blaine, MN
NPI 1760616031 · NPPES record last updated May 11, 2022
Key facts
- NPI
- 1760616031
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- Legal business name
- BLAINE MN MULTI SPECIALTY ASC LLC
- Practice address
- 11855 Ulysses St NE
Suite 270
Blaine, MN 55434-3947 - Phone
- (763) 755-6540
- NPI assigned
- May 14, 2009
- Organization subpart
- No
Authorized official
- Name
- Jeffrey E. Snodgrass
- Title
- President
- Phone
- (615) 665-1283
Member of 3
Medicare Care Compare: Ambulatory surgical center
- Listed as
- 2201 Blaine MN Multi Dba North Metro Surgery Center
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D1105289 | North Metro Surgery Center | Certificate of waiver | Sep 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090806000199 | MN | Part B Supplier - Ambulatory Surgical Center | 5294888301 | Practice locations: Blaine, MN |
National Provider Directory
Locations
11855 Ulysses St NE
Ste 270
Blaine, MN 55434
Phone (763) 755-6540
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | MN | Yes |
Addresses
Primary practice location
11855 Ulysses St NE
Suite 270
Blaine, MN 55434-3947
Mailing address
1A Burton Hills Blvd
Nashville, TN 37215-6187
Phone (615) 665-1283
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00825924 | Other | MN | RAILROAD |
Other names
- North Metro Surgery Center
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All providers in Blaine, MN · Ambulatory Surgical Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.