Provider Demographics
NPI:1134685415
Name:SOUTHFIELD SURGERY CENTER LLC
Entity Type:Organization
Organization Name:SOUTHFIELD SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:FAHD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-SAGHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-541-7801
Mailing Address - Street 1:26225 GREENFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4704
Mailing Address - Country:US
Mailing Address - Phone:248-541-7801
Mailing Address - Fax:248-541-7809
Practice Address - Street 1:26225 GREENFIELD ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-4704
Practice Address - Country:US
Practice Address - Phone:248-541-7801
Practice Address - Fax:248-541-7809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHFIELD SURGERY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-12
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical