PAVILION SURGERY CENTER LLC NPI 1649223629

NPI Information

NPI: 1649223629
Provider Name: PAVILION SURGERY CENTER, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 24D0980654

Address:
920 E 1ST ST
SUITE P-101
DULUTH, MN
ZIP 55805
Phone: (218) 279-6200
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PAVILION SURGERY CENTER, LLC is an ambulatory surgical clinic center in Duluth, MN. PAVILION SURGERY CENTER, LLC NPI is 1649223629. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

920 E 1ST ST
SUITE P-101
DULUTH, MN
ZIP 55805-201
Phone: (218) 279-6200
Fax: (218) 279-6205

The provider's authorized official is Katherine Becker .
The authorized official title is Vp Compliance and has the following contact phone number (218) 249-5555.

The CLIA number assigned to this NPI record is 24D0980654 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/18/2006 and was last updated on 11/24/2021.

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
1	367500000X	Nurse Anesthetist, Certified Registered				No
2	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	090973400	MEDICAID	MINNESOTA

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: 11/14/2023

NPI Synchronization or Removal

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