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ST. CLOUD EAR, NOSE & THROAT - SURGICAL SUITES LLC
NPI 1417188830
Clinic/Center - Ambulatory Surgical in Saint Cloud, MN

Active since August 03, 2009CLIA 24D0405700 · Waiver
1528 NORTHWAY DR, SAINT CLOUD, MN 56303(320) 252-0233(320) 257-1126 Get Directions Write a Review

NPPES record last updated: August 3, 2009. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About St. Cloud Ear, Nose & Throat - Surgical Suites Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST. CLOUD EAR, NOSE & THROAT - SURGICAL SUITES LLC (NPI 1417188830) is a healthcare organization registered as an ambulatory surgical in Saint Cloud, Minnesota and active in the NPI registry since August 2009. The organization holds a CLIA Waiver certificate valid through January 31, 2028 and lists Larry R Boller, Administrator, as its authorized official.

NPPES Registry Identity

NPI1417188830
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameST. CLOUD EAR, NOSE & THROAT - SURGICAL SUITES LLC
Location Address1528 NORTHWAY DRSaint Cloud, MN 56303-1255
Mailing Address1528 Northway DrSaint Cloud, MN 56303-1255 · (320) 252-0233 · Fax (320) 252-1421
Phone(320) 252-0233
Fax(320) 257-1126
Organization SubpartNo
Authorized OfficialLarry R BollerAdministrator · (320) 252-0233
Enumeration DateAugust 3, 2009
✔ NPI 1417188830 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
License✔ Licensed · PENDING
1528 NORTHWAY DR, Saint Cloud, MN 56303
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D0405700

St Cloud Ear Nose Throat Neck & Head · Saint Cloud, MN
Active · expires Jan 31, 2028
CLIA Number24D0405700
Laboratory TypePhysician Office
Certificate Effective DateFebruary 1, 2026
Certificate Expiration DateJanuary 31, 2028
Laboratory DirectorEmily Jacobs
Laboratory Phone(320) 252-0233
Laboratory LocationSt Cloud Ear Nose Throat Neck & Head1528 Northway Drive, Saint Cloud, MN 56303
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KARI A KREIN CCC-SLP
Speech-Language Pathologist
1528 NORTHWAY DR
SAINT CLOUD, MN 56303
Stearns County (320) 252-0233
STEPHEN CRAGLE MD
Otolaryngology
1528 NORTHWAY DR
SAINT CLOUD, MN 56303
Stearns County (320) 252-0233
MARTHA ANNE IDEKER AUD
Audiologist
1528 NORTHWAY DR
SAINT CLOUD, MN 56303
Stearns County (320) 252-0233
ST. CLOUD EAR, NOSE & THROAT CLINIC, P.A.
Otolaryngology
1528 NORTHWAY DR
SAINT CLOUD, MN 56303
Stearns County (320) 252-0233
MRS. AMY CORINNE DEARKING M.D.
Otolaryngology
1528 NORTHWAY DR
SAINT CLOUD, MN 56303
Stearns County (320) 252-0233
CASANDRA CONLEE WAHL AUD
Audiologist
1528 NORTHWAY DR
SAINT CLOUD, MN 56303
Stearns County (320) 252-0233
GERALD JURGENS M.D.
Otolaryngology
1528 NORTHWAY DR
SAINT CLOUD, MN 56303
Stearns County (320) 252-0233
ROSHNI MARIAN RAJA AUD
Audiologist
1528 NORTHWAY DR
SAINT CLOUD, MN 56303
Stearns County (320) 252-0233

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St. Cloud Ear, Nose & Throat - Surgical Suites LLC's NPI number?

The NPI number for St. Cloud Ear, Nose & Throat - Surgical Suites LLC is 1417188830. It was assigned to this organization in the NPPES registry on August 3, 2009.

Where is St. Cloud Ear, Nose & Throat - Surgical Suites LLC located?

St. Cloud Ear, Nose & Throat - Surgical Suites LLC is located at 1528 Northway Dr, Saint Cloud, MN 56303. The listed phone number is (320) 252-0233.

What is St. Cloud Ear, Nose & Throat - Surgical Suites LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Does St. Cloud Ear, Nose & Throat - Surgical Suites LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D0405700) is associated with this NPI, valid through January 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for St. Cloud Ear, Nose & Throat - Surgical Suites LLC was last updated on August 3, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.