MEDPARK SPECIALIZED SURGERY LLC NPI 1184375545

NPI Information

  • NPI: 1184375545
  • Provider Name: MEDPARK SPECIALIZED SURGERY, LLC
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • CLIA Number: 35D2253048
  • Address: 4450 31ST AVE S STE 201
    FARGO, ND
    ZIP 58104
  • Phone: (701) 293-9829

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NPI Details

MEDPARK SPECIALIZED SURGERY, LLC is an ambulatory surgical clinic center in Fargo, ND. MEDPARK SPECIALIZED SURGERY, LLC NPI is 1184375545. The provider is registered as an organization entity type.

The provider's business location address is:

4450 31ST AVE S STE 201
FARGO, ND
ZIP 58104-556
Phone: (701) 293-9829

The provider's authorized official is Leslie Heitkamp .
The authorized official title is Director and has the following contact phone number (701) 951-2022.

The CLIA number assigned to this NPI record is 35D2253048 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/17/2022 and was last updated on 3/24/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory SurgicalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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