Basic Information
| Provider Information | |||||||||
| NPI: | 1902805278 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EAST METRO ASC LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HIGH POINTE SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8650 HUDSON BLVD N | ||||||||
| Address2: | |||||||||
| City: | LAKE ELMO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550428448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517027400 | ||||||||
| FaxNumber: | 6517027414 | ||||||||
| Practice Location | |||||||||
| Address1: | 8650 HUDSON BLVD N | ||||||||
| Address2: | |||||||||
| City: | LAKE ELMO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550428448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517027400 | ||||||||
| FaxNumber: | 6517027414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ALBERS | ||||||||
| AuthorizedOfficialFirstName: | TRACI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6517027400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 327374 | MN | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 60029 | 01 | CHOICE PLUS | OTHER | F832674 | 01 | ARAZ | OTHER | 01018592 | 01 | PREFERED ONE | OTHER | 125683 | 01 | UCARE MINN | OTHER | 6Y86HI | 01 | ATRIUM 220G | OTHER | 138945900 | 01 | US DEPT OF LABOR | OTHER | 41910100 | 01 | WISCONSIN MEDICAL ASST | OTHER | 60029 | 01 | HEALTHPARTNERS | OTHER | 6800034 | 01 | MEDICA | OTHER | 6Y86HI | 01 | BCBS 220 G | OTHER | 1720088 | 01 | FIRST HEALTH | OTHER | 6Y86HI | 01 | HEALTH & WELFARE FUND | OTHER |