Basic Information
| Provider Information | |||||||||
| NPI: | 1962463133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL CENTERS OF MICHIGAN, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 YORK RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | JAMISON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189291098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155899024 | ||||||||
| FaxNumber: | 8337056301 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 INVESTMENT DR | ||||||||
| Address2: | STE 270 | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480986365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867268423 | ||||||||
| FaxNumber: | 5867268557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | MICHALEK | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5867268423 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 636907 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 40001 | 01 | MI | BLUE CROSS BLUE SHIELD MI | OTHER | 636907 | 01 | MI | MI STATE LICENSE | OTHER |