1518957729 NPI number — NORTHWEST MICHIGAN SURGERY CENTER LLC

Table of content: (NPI 1518957729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518957729 NPI number — NORTHWEST MICHIGAN SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST MICHIGAN SURGERY CENTER LLC
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:
1518957729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 PARK FOREST DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-6725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-392-8900
Provider Business Mailing Address Fax Number:
231-392-8973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 PARK FOREST DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49684-6725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-392-8900
Provider Business Practice Location Address Fax Number:
231-392-8973
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PIOTROWSKI
Authorized Official First Name:
TINA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
231-392-8950

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  286173 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38217 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40340 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P118278 . This is a "BLUE CARE NETWORK MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 487354900 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 104539 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 40340 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P118278 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 00099448 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 487354900 . This is a "ASR CORP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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