1386220895 NPI number — BLOOMFIELD HILLS SURGERY CENTER

Table of content: (NPI 1386220895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386220895 NPI number — BLOOMFIELD HILLS SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOMFIELD HILLS SURGERY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386220895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
359 ENTERPRISE CT STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48302-0305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-220-7505
Provider Business Mailing Address Fax Number:
248-985-3355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
359 ENTERPRISE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302-0305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-220-7505
Provider Business Practice Location Address Fax Number:
248-985-3355
Provider Enumeration Date:
03/23/2021

Additional Information

Authorized Official

Authorized Official Last Name:
TRUJILLO
Authorized Official First Name:
BILJANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
248-220-7505

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 63-6035 . This is a "CON APPLICATION NO. 20-0034" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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