Provider Demographics
NPI:1225256324
Name:THE SURGERY CENTER
Entity Type:Organization
Organization Name:THE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GROCHOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-929-3888
Mailing Address - Street 1:5080 N ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9230
Mailing Address - Country:US
Mailing Address - Phone:231-929-3888
Mailing Address - Fax:231-929-4365
Practice Address - Street 1:5080 N ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9230
Practice Address - Country:US
Practice Address - Phone:231-929-3888
Practice Address - Fax:231-929-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICG1308OtherCRNA/MD RAILROAD MEDICARE
MI0M58250Medicare PIN