1962463133 NPI number — SURGICAL CENTERS OF MICHIGAN, LLC.

Table of content: (NPI 1962463133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962463133 NPI number — SURGICAL CENTERS OF MICHIGAN, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL CENTERS OF MICHIGAN, 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:
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:
1962463133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 YORK RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMISON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18929-1098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-589-9024
Provider Business Mailing Address Fax Number:
833-705-6301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 INVESTMENT DR
Provider Second Line Business Practice Location Address:
STE 270
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48098-6365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-726-8423
Provider Business Practice Location Address Fax Number:
586-726-8557
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MICHALEK
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
SR BILLING MANAGER
Authorized Official Telephone Number:
586-726-8423

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  636907 , 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: 40001 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 636907 . This is a "MI STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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