1679526297 NPI number — WEST BLOOMFIELD SURGERY CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679526297 NPI number — WEST BLOOMFIELD SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST BLOOMFIELD 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:
1679526297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 HAGGERTY RD
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48323-2184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-896-6300
Provider Business Mailing Address Fax Number:
248-896-6321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 HAGGERTY RD
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48323-2184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-896-6300
Provider Business Practice Location Address Fax Number:
248-896-6321
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALDOCK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
BOYD
Authorized Official Title or Position:
OFFICER AND AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
615-234-5954

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  63-6923 , 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)





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