Provider Demographics
NPI:1134291586
Name:SURGICAL ASSOCIATES OF T CITY PLLC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF T CITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SMELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-2401
Mailing Address - Street 1:1221 SIXTH ST
Mailing Address - Street 2:STE. 306
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2701
Mailing Address - Country:US
Mailing Address - Phone:231-935-2400
Mailing Address - Fax:231-935-2424
Practice Address - Street 1:1221 SIXTH ST. STE. 306
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-2400
Practice Address - Fax:231-935-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty