OrganizationInstitute Of Facial Surgery St Paul, PllcClinic/CenterAmbulatory Health Care FacilitiesPractice Address1774 Cope Ave E, Suite 140, Maplewood, MN 55109-2662(651) 774-9611PECOS EnrollmentBased on the most recent information from CMS, provider Institute Of Facial Surgery St Paul, Pllc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1477871457Provider TypeOrganizationFull NameInstitute Of Facial Surgery St Paul, PllcSubpartNoEnumeration Date5/14/2010Last Updated4/21/2011Contact InformationPractice LocationPractice Address1774 Cope Ave E, Suite 140, Maplewood, MN 55109-2662Phone(651) 774-9611Fax(651) 748-3704Mailing LocationMailing Address1774 Cope Ave E, Suite 140, Maplewood, MN 55109-2662Phone(651) 774-9611Fax(651) 748-3704Authorized OfficialNameBrunsoman, Jerry Kent (President)Phone(651) 774-9611Provider TaxonomiesCodeDescriptionLicenseCode261QD0000XPrimaryDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseD6950Minnesota