Basic Information
| Provider Information | |||||||||
| NPI: | 1861434151 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROSBY CARDIOVASCULAR SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 E 28TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128633900 | ||||||||
| FaxNumber: | 6128638887 | ||||||||
| Practice Location | |||||||||
| Address1: | 318 E MAIN ST | ||||||||
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| City: | CROSBY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 564411645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2185464334 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 03/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | PIETZ | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SEC/TREAS | ||||||||
| AuthorizedOfficialTelephone: | 6128636175 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.